Organization
.MORTENSON FAMILY DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OWEN WAYNE MORTENSON DMD (DENTIST OWNER)
(502) 245-8627
Entity
Organization
Contact information
Practice address
4801 OUTER LOOP, LOUISVILLE, KY 40219-3201
(502) 966-8638
(502) 964-7309
Mailing address
PO BOX 437169, LOUISVILLE, KY 40253-7169
(502) 245-7103
(502) 253-2202
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
11/29/2006
Last updated
08/22/2020
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