Mortimer Family Dentistry, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901014445 Issued in MI

Legal business name

MORTIMER FAMILY DENTISTRY, PC

Practice address

4495 S Center Rd
Burton, MI 48519-1417

Phone

(810) 743-5131

Fax

(810) 743-1111

NPI assigned

Apr 17, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Scott Allen Mortimer, D.D.S.NPI 1861439978

Title

President

Phone

(810) 743-5131

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Scott Allen Mortimer, D.D.S.

  • General Practice Dentistry
  • Burton, MI
  • NPI 1861439978
  Medicare reassignment NPD Authorized official
• Allen Wayne Mortimer, DDS

  • General Practice Dentistry
  • Burton, MI
  • NPI 1972867851
  Medicare reassignment NPD

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

{
    "created_epoch": "1208390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436918400000",
    "number": "1417121732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4495 S CENTER RD",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485191417",
            "telephone_number": "810-743-5131",
            "fax_number": "810-742-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4495 S CENTER RD",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485191417",
            "telephone_number": "810-743-5131",
            "fax_number": "810-743-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORTIMER FAMILY DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-17",
        "last_updated": "2015-07-15",
        "status": "A",
        "authorized_official_last_name": "MORTIMER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "810-743-5131",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901014445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Destiny Morris
• Elaina Shapri Morris
• Jaquavion Morris
• Tina M Morrison
• Rhonda Jean Morse, NP
• Allen Wayne Mortimer, DDS
• Scott Allen Mortimer, D.D.S.
• Breanna Moslander
• Erica Wendy Moslander
• Danielle Latresa Mosley

• General Practice Dentistry in Burton, MI
• Providers in Burton, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.