Organization · NPI-2

.Mortenson Family Dental Center

Clinic/Center, Dental · Louisville, KY

NPI number1720155591
StatusActive
Last updated in NPPESAug 22, 2020

Details

NPI
1720155591
Entity type
Organization (NPI-2)
Legal business name
.Mortenson Family Dental Center
Organization subpart
No
Enumeration date
Nov 29, 2006
Last updated
Aug 22, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QD0000X Clinic/Center, Dental––Yes

Practice location

4801 Outer Loop
Louisville, KY 40219-3201

Phone 502-966-8638 · Fax 502-964-7309

Mailing address

Po Box 437169
Louisville, KY 40253-7169

Phone 502-245-7103 · Fax 502-253-2202

Authorized official

Owen Wayne Mortenson
Dentist Owner
5022458627

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