NPIMap

Organization Active NPI

Mortenson Family Dental Center- Clarksville, LLC

  • General Practice Dentistry
  • Clarksville, IN
National Provider Identifier
1467623629
Registry record updated Oct 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12010767A Issued in IN
Legal business name
MORTENSON FAMILY DENTAL CENTER- CLARKSVILLE, LLC
Doing business as
Smilecare Family Dental
Practice address
1240 Veterans Parkway
Suite 100
Clarksville, IN 47129
Phone
(812) 284-2701
Fax
(812) 284-2721
NPI assigned
Mar 17, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2012

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

Authorized official

Name
Stephen James, CFO
Title
Cfo
Phone
(502) 254-8504

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 12010767A IN Primary

Addresses

Primary practice location

1240 Veterans Parkway
Suite 100
Clarksville, IN 47129

Mailing address

1240 Veterans Parkway
Suite 100
Clarksville, IN 47129
Phone (812) 284-2701

Other names 1

  • Smilecare Family Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mortenson Family Dental Center- Clarksville2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1205712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350345600000",
    "number": "1467623629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 VETERANS PARKWAY",
            "address_2": "SUITE 100",
            "city": "CLARKSVILLE",
            "state": "IN",
            "postal_code": "47129",
            "telephone_number": "812-284-2701",
            "fax_number": "812-284-2721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 VETERANS PARKWAY",
            "address_2": "SUITE 100",
            "city": "CLARKSVILLE",
            "state": "IN",
            "postal_code": "47129",
            "telephone_number": "812-284-2701",
            "fax_number": "812-284-2721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORTENSON FAMILY DENTAL CENTER- CLARKSVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-17",
        "last_updated": "2012-10-16",
        "status": "A",
        "authorized_official_last_name": "JAMES",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "502-254-8504",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010767A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smilecare Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarksville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 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.