Mark Mortenson, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8834 Issued in KY

Practice address

1746 Highway 44 E
Shepherdsville, KY 40165-6131

Phone

(502) 543-2278

Fax

(502) 531-9303

NPI assigned

Jan 22, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Engilman Orthodontics-Shepherdsville, PLLC

  • Dental Clinic/Center
  • Shepherdsville, KY
  • NPI 1033347869
  NPD (past)
• Mortenson Family Dental

  • Dental Clinic/Center
  • Shepherdsville, KY
  • NPI 1306949466
  NPD (past)
• Mortenson Family Dental Center Hilliview-Okolona PLLC

  • Dental Clinic/Center
  • Louisville, KY
  • NPI 1467564112
  NPD (past)

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

{
    "created_epoch": "1264118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380067200000",
    "number": "1811228307",
    "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": "502-254-8501",
            "fax_number": "502-805-1957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1746 HIGHWAY 44 E",
            "city": "SHEPHERDSVILLE",
            "state": "KY",
            "postal_code": "401656131",
            "telephone_number": "502-543-2278",
            "fax_number": "502-531-9303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTENSON",
        "first_name": "MARK",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-01-22",
        "last_updated": "2013-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "8834",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "8834",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100139450",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mobility Access Providers
• Jerri L Molina, APRN
• Paula Morgan, PH.D.
• Amy Lynn Morris, PTA
• Mortenson Family Dental
• Alice Moss
• Molly Danielle Mudd
• Victoria Hope Mudd, APRN
• Teresa Diann Murphy, RD, LD
• Rohini Naidoo- Frost, B.PHARM

• General Practice Dentistry in Shepherdsville, KY
• Providers in Shepherdsville, 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 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.