Individual
DR. SAMUEL A MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 263-1200
(602) 200-5383
Mailing address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 263-1200
(602) 200-5383
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7351
AZ
1223G0001X
General Practice Dentistry
DEN.00201822
CO
Other
Enumeration date
08/15/2007
Last updated
07/29/2015
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