Mortenson Family Dental Center - Simpsonville, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MORTENSON FAMILY DENTAL CENTER - SIMPSONVILLE, PLLC

Practice address

137 Buck Creek Rd
Simpsonville, KY 40067-6674

Phone

(502) 722-2110

Fax

(502) 722-2116

NPI assigned

Nov 15, 2012

Last updated

Nov 15, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ronel McCombs

Title

Credentialing Specialist

Phone

(502) 254-8500

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352937600000",
    "number": "1285978288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 437169",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402537169",
            "telephone_number": "502-254-8500",
            "fax_number": "502-245-5021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "137 BUCK CREEK RD",
            "city": "SIMPSONVILLE",
            "state": "KY",
            "postal_code": "400676674",
            "telephone_number": "502-722-2110",
            "fax_number": "502-722-2116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORTENSON FAMILY DENTAL CENTER - SIMPSONVILLE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-15",
        "last_updated": "2012-11-15",
        "status": "A",
        "authorized_official_last_name": "MCCOMBS",
        "authorized_official_first_name": "RONEL",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "502-254-8500"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristin Huber, RNFA
• Jewish Hospital & St. Mary's Healthcare, Inc. (JHS Shelby Medicine)
• Natalie Macdonald, SLP
• Ronald McClish, RPH
• Tonya Miller, PT, ATC
• North Central District Health Dept (Simpsonville Elementary School Satellite Clinic)
• Kerrin Omer
• Mary Dana Overall McClellan, RN
• Parker Bowling, LLC
• Carolyn Pike, LMT

• General Practice Dentistry in Simpsonville, KY
• Providers in Simpsonville, KY by specialty
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.