Organization
MORTENSON FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OWEN WAYNE MORTENSON DMD (GEN DENTIST/OWNER)
(502) 245-8627
Entity
Organization
Contact information
Practice address
2005 S HIGHWAY 53, LAGRANGE, KY 40031-9109
(502) 225-0074
(502) 225-0882
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
—
—
Other
Enumeration date
08/31/2006
Last updated
08/22/2020
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