Organization
MORTENSON FAMILY DENTAL CTR-JEFFERSONVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OWEN WAYNE MORTENSON DMD (OWNER PROVIDER)
(502) 245-8627
Entity
Organization
Contact information
Practice address
2917 HWY 62, JEFFERSONVILLE, IN 47130
(812) 288-1000
Mailing address
134 N EVERGREEN RD, SUITE 102, MIDDLETOWN, KY 40243-1487
(502) 245-7103
(502) 253-2202
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
IN
Other
Enumeration date
07/05/2007
Last updated
08/22/2020
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