# MORTENSON FAMILY DENTAL

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1477665156
- **Authorized official:** DR. OWEN WAYNE MORTENSON DMD (GEN DENTIST/OWNER)
- **Authorized official phone:** (502) 245-8627

## Contact information

- **Practice address:** 2441 STATE ST, NEW ALBANY, IN 47150-4962
- **Practice address phone:** (812) 941-8500
- **Practice address fax:** (812) 944-1602
- **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 | — | — | Yes |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 08/22/2020