Individual provider Active NPI

Robert Manning Mortensen

  • Dentist
  • Anchorage, AK
National Provider Identifier
1902863905
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
13666 Issued in MO
Practice address
2925 Debarr Rd
Alaska VA Health Care System/Regional Office, (160)
Anchorage, AK 99508
Phone
(907) 257-4940
Fax
(907) 257-4953
NPI assigned
Apr 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 13666 MO Primary

Addresses

Primary practice location

2925 Debarr Rd
Alaska VA Health Care System/Regional Office, (160)
Anchorage, AK 99508

Mailing address

19633 Big Diomede Cir
Eagle River, AK 99577-8797
Phone (907) 696-8776

Other identifiers 3

IdentifierTypeStateIssuer
5614OtherNEDENTAL LISENCE
13666OtherMODENTAL LISENCE
5510OtherKSDENTAL LISENCE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
13666MOMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1902863905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19633 BIG DIOMEDE CIR",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995778797",
            "telephone_number": "907-696-8776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2925 DEBARR RD",
            "address_2": "ALASKA VA HEALTH CARE SYSTEM/REGIONAL OFFICE, (160)",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "99508",
            "telephone_number": "907-257-4940",
            "fax_number": "907-257-4953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTENSEN",
        "first_name": "ROBERT",
        "middle_name": "MANNING",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "13666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LISENCE",
            "identifier": "5614",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LISENCE",
            "identifier": "13666",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LISENCE",
            "identifier": "5510",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anchorage, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.