Organization
ALPINE DENITSTRY
Active
Other names
Tyler Bergien, DDS
Organization subpart
No
Provider details
NPI number
Authorized official
KIFFIN HANSEN (OFFICE MANAGER)
(307) 734-5200
Entity
Organization
Contact information
Practice address
945 W BROADWAY AVE APT 201, JACKSON, WY 83001-8217
(307) 734-5200
(307) 733-2922
Mailing address
PO BOX 11779, JACKSON, WY 83002-1779
(307) 734-5200
(307) 733-2922
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1669683025
NPI TYPE 1
WY
Enumeration date
03/13/2020
Last updated
03/13/2020
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