Bighorn Orthodontics LLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

1344 Issued in WY

Legal business name

BIGHORN ORTHODONTICS LLC

Practice address

642 Val Vista St
Suite B
Sheridan, WY 82801-3659

Phone

(307) 672-6917

NPI assigned

Oct 28, 2014

Organization subpart

No

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

Authorized official

Name

Micah G. Mortensen, DDS, MSD

Title

Owner

Phone

(801) 831-2662

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1414454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414454400000",
    "number": "1295130631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "642 VAL VISTA ST",
            "address_2": "SUITE B",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828013659",
            "telephone_number": "307-672-6917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "642 VAL VISTA ST",
            "address_2": "SUITE B",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828013659",
            "telephone_number": "307-672-6917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIGHORN ORTHODONTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-28",
        "last_updated": "2014-10-28",
        "status": "A",
        "authorized_official_last_name": "MORTENSEN",
        "authorized_official_first_name": "MICAH",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-831-2662",
        "authorized_official_credential": "DDS,  MSD"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "WY",
            "license": "1344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Sheridan, WY
• Providers in Sheridan, WY by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2014; 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.