.Mortenson Family Dental Center
Organization Active NPI Dental Clinic/Center · Louisville, KY
NPI 1720155591 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1720155591
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dental Clinic/Center 261QD0000X
- Legal business name
- .MORTENSON FAMILY DENTAL CENTER
- Practice address
- 4801 Outer Loop
Louisville, KY 40219-3201 - Phone
- (502) 966-8638
- Fax
- (502) 964-7309
- NPI assigned
- Nov 29, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Owen Wayne Mortenson, DMD
- Title
- Dentist Owner
- Phone
- (502) 245-8627
National Provider Directory
Locations
4801 Outer Loop
Louisville, KY 40219
Phone (502) 966-8638
4801 Outer Loop
Ste A204
Louisville, KY 40219
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | Yes |
Addresses
Primary practice location
4801 Outer Loop
Louisville, KY 40219-3201
Mailing address
PO Box 437169
Louisville, KY 40253-7169
Phone (502) 245-7103
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All providers in Louisville, KY · Dental Clinic/Center in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.