# MORTENSON FAMILY DENTAL CTR-JEFFERSONVILLE

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

## Provider details

- **NPI number:** 1447458070
- **Authorized official:** OWEN WAYNE MORTENSON DMD (OWNER PROVIDER)
- **Authorized official phone:** (502) 245-8627

## Contact information

- **Practice address:** 2917 HWY 62, JEFFERSONVILLE, IN 47130
- **Practice address phone:** (812) 288-1000
- **Mailing address:** 134 N EVERGREEN RD, SUITE 102, MIDDLETOWN, KY 40243-1487
- **Mailing address phone:** (502) 245-7103
- **Mailing address fax:** (502) 253-2202

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | IN | Yes |

## Other

- **Enumeration date:** 07/05/2007
- **Last updated:** 08/22/2020