Individual
MARK MORTENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1746 HIGHWAY 44 E, SHEPHERDSVILLE, KY 40165-6131
(502) 543-2278
(502) 531-9303
Mailing address
PO BOX 437169, LOUISVILLE, KY 40253-7169
(502) 254-8501
(502) 805-1957
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
8834
KY
1223G0001X
General Practice Dentistry
Primary
8834
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100139450
—
KY
Enumeration date
01/22/2010
Last updated
09/25/2013
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