Dr. Samuel A Mortensen, D.M.D
Dentist, General Practice in Phoenix, AZ. Individual provider (NPI-1).
NPI number1427240282
StatusActive
Last updated in NPPESJul 29, 2015
Details
- NPI
- 1427240282
- Entity type
- Individual (NPI-1)
- Name
- Dr. Samuel A Mortensen
- Credential
- D.M.D
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 15, 2007
- Last updated
- Jul 29, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 7351 | AZ | Yes |
| 1223G0001X | Dentist, General Practice | DEN.00201822 | CO |
Practice location
4212 N 16th StPhoenix, AZ 85016-5319
Phone 602-263-1200 · Fax 602-200-5383
Mailing address
4212 N 16th StPhoenix, AZ 85016-5319
Phone 602-263-1200 · Fax 602-200-5383
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