# MORTENSON FAMILY DENTAL CENTER - LAWRENCEBURG LLC

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

## Provider details

- **NPI number:** 1508242827
- **Authorized official:** STEPHEN JAMES (CFO)
- **Authorized official phone:** (502) 254-8500

## Contact information

- **Practice address:** 1019 WEST EADS PARKWAY US 50, LAWRENCEBURG, IN 47102-1842
- **Practice address phone:** (502) 254-8500
- **Practice address fax:** (502) 805-1957
- **Mailing address:** 1019 WEST EADS PARKWAY US 50, LAWRENCEBURG, IN 47102-1842
- **Mailing address phone:** (502) 254-8500
- **Mailing address fax:** (502) 805-1957

## Taxonomy

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

## Other

- **Enumeration date:** 08/10/2015
- **Last updated:** 08/10/2015