Mortenson Family Dental Center - Maineville LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

MORTENSON FAMILY DENTAL CENTER - MAINEVILLE LLC

Practice address

6028 South State Road 48
Maineville, OH 45039

Phone

(513) 334-4099

Fax

(513) 453-7179

NPI assigned

Jan 24, 2017

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 2

Addresses

Other names 1

• Kids Dentistree - Maineville Doing business as

Locations

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

{
    "created_epoch": "1485216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671062400000",
    "number": "1760929103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 437169",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402537169",
            "telephone_number": "513-334-4099",
            "fax_number": "513-453-7179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6028 SOUTH STATE ROAD 48",
            "city": "MAINEVILLE",
            "state": "OH",
            "postal_code": "45039",
            "telephone_number": "513-334-4099",
            "fax_number": "513-453-7179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORTENSON FAMILY DENTAL CENTER - MAINEVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-24",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "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": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kids Dentistree - Maineville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Mollman
• Christine Murphy Moore, RPH
• Michelle Ann Moore
• Kimberly Morris
• Mortenson Family Dental Center - Landen LLC
• Sara Moyer
• Michelle Lynn Murad
• Mayank Naik
• Lauren Napier
• Adison Neal

• Pediatric Dentistry in Maineville, OH
• Providers in Maineville, OH by specialty
• Pediatric Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2022; 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.