# MORTENSON FAMILY DENTAL CENTER - SIMPSONVILLE, PLLC

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

## Provider details

- **NPI number:** 1285978288
- **Authorized official:** RONEL MCCOMBS (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (502) 254-8500

## Contact information

- **Practice address:** 137 BUCK CREEK RD, SIMPSONVILLE, KY 40067-6674
- **Practice address phone:** (502) 722-2110
- **Practice address fax:** (502) 722-2116
- **Mailing address:** PO BOX 437169, LOUISVILLE, KY 40253-7169
- **Mailing address phone:** (502) 254-8500
- **Mailing address fax:** (502) 245-5021

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 11/15/2012
- **Last updated:** 11/15/2012