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Individual
BRENT W MORTENSON
Active
Individual
BRENT W MORTENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
7229
KY
1223P0221X
Pediatric Dentistry
7229
KY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
7229
KY
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
7229
KY
Other
Enumeration date
07/18/2006
Last updated
06/18/2014
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