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Organization
WAYNE MORTENSEN DMD PC
Active
Organization
WAYNE MORTENSEN DMD PC
Active
Other names
Smiles on State Street
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE MORTENSEN DMD (DR/OWNER)
(208) 853-3300
Entity
Organization
Contact information
Practice address
9213 W STATE ST, BOISE, ID 83714-1737
(208) 853-3300
Mailing address
9213 W STATE ST, BOISE, ID 83714-1737
(208) 853-3300
(208) 258-3282
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
11/09/2021
Last updated
07/06/2023
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