Brent W Mortenson, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

7229 Issued in KY

Practice address

134 Evergreen Rd
Suite 103
Louisville, KY 40243-1487

Phone

(502) 410-1702

Fax

(502) 244-0817

NPI assigned

Jul 18, 2006

Last updated

Jun 18, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Oral Surgery

Education

University of Louisville School of Dentistry, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oral Surgery Group of Frankfort, PLLCGroup PAC ID 9335327964, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Oral Surgery Group of Frankfort, PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Frankfort, KY
  • NPI 1568768224
  Medicare reassignment Care Compare group
• Oral Surgery Group of Middletown, PLLC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Middletown, KY
  • NPI 1497070148
  Medicare reassignment
• Kentucky Center for Oral & Maxillofacial Surgery PSC

  • Oral and Maxillofacial Surgery (Dentist)
  • Richmond, KY
  • NPI 1457379307
  NPD (past)
• Periodontic & Endodontic Services-Jefferson Mall, PLLC

  • Dental Clinic/Center
  • Louisville, KY
  • NPI 1578853982
  NPD (past)

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403049600000",
    "number": "1356369169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 EVERGREEN RD",
            "address_2": "SUITE 103",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402431487",
            "telephone_number": "502-410-1702",
            "fax_number": "502-244-0817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 EVERGREEN RD",
            "address_2": "SUITE 103",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402431487",
            "telephone_number": "502-410-1702",
            "fax_number": "502-244-0817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTENSON",
        "first_name": "BRENT",
        "middle_name": "W",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2014-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "7229",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "KY",
            "license": "7229",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "KY",
            "license": "7229",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "KY",
            "license": "7229",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64072291",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60072295",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mortenson Family Dental Center-Dupont,PLLC (Mortenson Family Dental Center - Hikes Point)
• Mortenson Family Dental Center-Forest Green, PLLC
• Mortenson Family Dental Center-Highlands PLLC
• Mortenson Family Dental Center-Jeffersontown, PLLC
• Mortenson Family Dental Center-Valley Station
• Kate Lindsey Mortenson, DMD
• Matthew Mortenson, DMD
• Sean Mortenson, APRN
• Mortensonfamilydentalcenter-Buechel, PLLC
• Bailey Lauren Mortis, LMFT

• Oral and Maxillofacial Surgery (Dentist) in Louisville, KY
• Providers in Louisville, KY by specialty
• Oral and Maxillofacial Surgery (Dentist) in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.