# MORTENSON FAMILY DENTAL CENTER - DIXIE AT ROCKFORD LANE, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013309905
- **Authorized official:** STEPHEN JAMES (CFO)
- **Authorized official phone:** (502) 254-8500

## Contact information

- **Practice address:** 4740 DIXIE HWY, LOUISVILLE, KY 40216-2656
- **Practice address phone:** (502) 447-8992
- **Mailing address:** 4740 DIXIE HWY, LOUISVILLE, KY 40216-2656
- **Mailing address phone:** (502) 447-8992

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 03/02/2015
- **Last updated:** 03/02/2015