Ennis Hometown Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ENNIS HOMETOWN DENTAL

Practice address

400 W Ennis Ave
Ennis, TX 75119-3904

Phone

(972) 875-9031

Fax

(972) 878-9031

NPI assigned

Mar 5, 2025

Last updated

Mar 5, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jorden Mark Mortensen, DMDNPI 1962069369

Title

Owner

Phone

(512) 520-6365

Specialties & licenses 1

Addresses

Locations

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.

• Jorden Mark Mortensen, DMD

  • General Practice Dentistry
  • Kingwood, TX
  • NPI 1962069369
  Authorized official Same address or phone
• Stephen C Durbin, DDS

  • Dentist
  • Ennis, TX
  • NPI 1548384431
  NPD (past)

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

{
    "created_epoch": "1741132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741132800000",
    "number": "1700684701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W ENNIS AVE",
            "city": "ENNIS",
            "state": "TX",
            "postal_code": "751193904",
            "telephone_number": "972-875-9031",
            "fax_number": "972-878-9031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W ENNIS AVE",
            "city": "ENNIS",
            "state": "TX",
            "postal_code": "751193904",
            "telephone_number": "972-875-9031",
            "fax_number": "972-878-9031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENNIS HOMETOWN DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-05",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A",
        "authorized_official_last_name": "MORTENSEN",
        "authorized_official_first_name": "JORDEN",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-520-6365",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ennis Dental PLLC
• Ennis Diagnostic Center, Inc. (Elite Medical Supply)
• Ennis Family Dentistry PLLC (Ennis Family Dentistry & Orthodontics)
• Ennis Healthcare Systems Inc
• Ennis Heart Center, PA
• Ennis Isd
• Ennis Midwifery LLC
• Ennis Nursing and Rehab Center LLC
• Ennis Orthopedics PA
• Ennis Pediatric and Adolescent Health Care Center, P.a.

• General Practice Dentistry in Ennis, TX
• Providers in Ennis, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2025; 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.