Organization Active NPI

Mortenson Family Dental

  • Dental Clinic/Center
  • Louisville, KY
National Provider Identifier
1376655498
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
MORTENSON FAMILY DENTAL
Practice address
5222 Dixie Hwy
Louisville, KY 40216-1704
Phone
(502) 449-7995
Fax
(502) 449-2028
NPI assigned
Aug 31, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Owen Wayne Mortenson
Title
Gen Dentist/Owner
Phone
(502) 245-8627

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

5222 Dixie Hwy
Louisville, KY 40216-1704

Mailing address

134 N Evergreen Rd
Louisville, KY 40243-1487
Phone (502) 245-7103

National Provider Directory

National Provider Directory

Locations

5222 Dixie Hwy
Louisville, KY 40216
Phone (502) 449-7995

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376655498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 N EVERGREEN RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402431487",
            "telephone_number": "502-245-7103",
            "fax_number": "502-253-2202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5222 DIXIE HWY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402161704",
            "telephone_number": "502-449-7995",
            "fax_number": "502-449-2028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORTENSON FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MORTENSON",
        "authorized_official_first_name": "OWEN",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "GEN DENTIST/OWNER",
        "authorized_official_telephone_number": "502-245-8627",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.