Active NPI
Sean Richard Mortensen, D.D.S.
- Dentist
- Pueblo, CO
National Provider Identifier
1104266949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 201996
- Practice address
- 2025 W US Highway 50
A100
Pueblo, CO 81008-1571 - Phone
- (719) 542-2472
- NPI assigned
- Jun 25, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 201996 | CO | Primary |
Addresses
Primary practice location
2025 W US Highway 50
A100
Pueblo, CO 81008-1571
Mailing address
2025 W US Highway 50
A100
Pueblo, CO 81008-1571
Phone (719) 542-2472
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 201996 | CO | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372118400000",
"number": "1104266949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2025 W US HIGHWAY 50",
"address_2": "A100",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810081571",
"telephone_number": "719-542-2472"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2025 W US HIGHWAY 50",
"address_2": "A100",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810081571",
"telephone_number": "719-542-2472"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORTENSEN",
"first_name": "SEAN",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-06-25",
"last_updated": "2013-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "201996",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.