Todd Mortenson, DMD
Individual provider Active NPI General Practice Dentistry · Lagrange, KY
NPI 1720195969 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1720195969
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 7374 (KY)
- Practice address
- 2005 S Highway 53
Lagrange, KY 40031-9109 - Phone
- (502) 225-0074
- Fax
- (502) 225-0882
- NPI assigned
- Aug 24, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160517000575 | KY | Order and Referring Only - Dentist |
9335327931 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7374 | KY | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mortenson Family Dental | Past | Accepting new patients | |
| Periodontic & Endodontic Services | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 7374 | KY | Yes |
Addresses
Primary practice location
2005 S Highway 53
Lagrange, KY 40031-9109
Mailing address
11708 Main St
Middletown, KY 40243-1426
Phone (502) 245-8627
Other providers in Lagrange, KY
- Morton Marye
- Medical Center Cardiologists, PSC
- Christopher Michno
- Christopher Scott Mitchell
- Mortenson Family Dental
- Oaktree Hospital at Baptist Northeast, LLC
- Oldham County Health Dept
- Oldham County Spine & Rehab Center PSC
- Lido L Petrucci
- Laurence Daniel Preble
All providers in Lagrange, KY · General Practice Dentistry in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.