# ENNIS HOMETOWN DENTAL

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

## Provider details

- **NPI number:** 1700684701
- **Authorized official:** JORDEN MARK MORTENSEN DMD (OWNER)
- **Authorized official phone:** (512) 520-6365

## Contact information

- **Practice address:** 400 W ENNIS AVE, ENNIS, TX 75119-3904
- **Practice address phone:** (972) 875-9031
- **Practice address fax:** (972) 878-9031
- **Mailing address:** 400 W ENNIS AVE, ENNIS, TX 75119-3904
- **Mailing address phone:** (972) 875-9031
- **Mailing address fax:** (972) 878-9031

## Taxonomy

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

## Other

- **Enumeration date:** 03/05/2025
- **Last updated:** 03/05/2025