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Organization

MORTENSON FAMILY DENTAL CENTER-HIGHLANDS PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
STEVE JAMES (CFO)
(502) 254-8504
Entity
Organization

Contact information

Practice address
2105 WEBER AVE, LOUISVILLE, KY 40205-2110
(502) 473-2011
(502) 473-2013
Mailing address
PO BOX 437169, LOUISVILLE, KY 40253-7169
(502) 254-8501
(502) 805-1957

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7100278400
KY
Enumeration date
09/29/2008
Last updated
09/17/2014
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