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Organization
MORTENSON FAMILY DENTAL CENTER - SIMPSONVILLE, PLLC
Active
Organization
MORTENSON FAMILY DENTAL CENTER - SIMPSONVILLE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONEL MCCOMBS (CREDENTIALING SPECIALIST)
(502) 254-8500
Entity
Organization
Contact information
Practice address
137 BUCK CREEK RD, SIMPSONVILLE, KY 40067-6674
(502) 722-2110
(502) 722-2116
Mailing address
PO BOX 437169, LOUISVILLE, KY 40253-7169
(502) 254-8500
(502) 245-5021
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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