Mortenson Family Dental Center - Independence, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MORTENSON FAMILY DENTAL CENTER - INDEPENDENCE, LLC

Practice address

2052 Harris Pike
Independence, KY 41051-7783

Phone

(859) 898-2255

Fax

(859) 898-2730

NPI assigned

Feb 9, 2017

Last updated

Sep 5, 2023By 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

Jeff Reibel

Title

Cfo

Phone

(502) 254-8500

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.

• Thomas Chisam, DMD

  • General Practice Dentistry
  • Independence, KY
  • NPI 1356236517
  NPD (past)
• Todd Matthew Thurman, DMD, FAGD

  • General Practice Dentistry
  • Independence, KY
  • NPI 1386219707
  NPD (past)

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

{
    "created_epoch": "1486598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693872000000",
    "number": "1760920805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2052 HARRIS PIKE",
            "city": "INDEPENDENCE",
            "state": "KY",
            "postal_code": "410517783",
            "telephone_number": "859-898-2255",
            "fax_number": "859-898-2730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2052 HARRIS PIKE",
            "city": "INDEPENDENCE",
            "state": "KY",
            "postal_code": "410517783",
            "telephone_number": "859-898-2255",
            "fax_number": "859-898-2730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORTENSON FAMILY DENTAL CENTER - INDEPENDENCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-09",
        "last_updated": "2023-09-05",
        "certification_date": "2023-09-05",
        "status": "A",
        "authorized_official_last_name": "REIBEL",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "502-254-8500"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aaron McCoy, MSN, APRN
• Charles Clay Meade, DPT
• Catrina Marie Meredith
• Lerin Middendorf, APRN, FNP-C
• Angela L Miller, LPN
• Ashley Joseph Moser, DMD
• Kimberly Jo Mullins, RPH
• Myeyedr Optometry of Kentucky, PLLC
• Joseph Matthew Naas, DMD
• Danny Nakhla, DDS

• General Practice Dentistry in Independence, KY
• Providers in Independence, KY by specialty
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2023; 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.