Individual
DR. MICAH G. MORTENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.D.
Contact information
Practice address
6287 S REDWOOD RD STE 202, SALT LAKE CITY, UT 84123-6655
(801) 262-3777
Mailing address
15359 W COLUMBINE DR, SURPRISE, AZ 85379-9190
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
4726746-9921
UT
Other
Enumeration date
12/15/2006
Last updated
06/15/2022
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