Active NPI
Jorden Mark Mortensen, DMD
- General Practice Dentistry
- Kingwood, TX
National Provider Identifier
1962069369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 35038
- Practice address
- 6006 Shady Birch Holw
Kingwood, TX 77345-2176 - Phone
- (512) 520-6365
- NPI assigned
- May 22, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 35038 | TX | Primary |
Addresses
Primary practice location
6006 Shady Birch Holw
Kingwood, TX 77345-2176
Mailing address
6006 Shady Birch Holw
Kingwood, TX 77345-2176
Phone (512) 520-6365
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
| License | State | Type | Specialty |
|---|---|---|---|
| 35038 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558483200000",
"number": "1962069369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6006 SHADY BIRCH HOLW",
"city": "KINGWOOD",
"state": "TX",
"postal_code": "773452176",
"telephone_number": "512-520-6365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6006 SHADY BIRCH HOLW",
"city": "KINGWOOD",
"state": "TX",
"postal_code": "773452176",
"telephone_number": "512-520-6365"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORTENSEN",
"first_name": "JORDEN",
"middle_name": "MARK",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-05-22",
"last_updated": "2019-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "35038",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kingwood, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.