Individual
TODD MORTENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2005 S HIGHWAY 53, LAGRANGE, KY 40031-9109
(502) 225-0074
(502) 225-0882
Mailing address
11708 MAIN ST, MIDDLETOWN, KY 40243-1426
(502) 245-8627
(502) 245-9395
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7374
KY
Other
Enumeration date
08/24/2006
Last updated
07/08/2007
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