Organization
WAYNE MORTENSEN DMD PC
Active
Other names
Smiles on State Street
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE MORTENSEN DMD (DR/OWNER)
(208) 853-3300
Entity
Organization
Contact information
Practice address
9213 W STATE ST, BOISE, ID 83714-1737
(208) 853-3300
Mailing address
9213 W STATE ST, BOISE, ID 83714-1737
(208) 853-3300
(208) 258-3282
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
11/09/2021
Last updated
07/06/2023
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