Organization
MORTENSON FAMILY DENTAL CENTER - SHELBYVILLE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN JAMES (CFO)
(502) 254-8504
Entity
Organization
Contact information
Practice address
130 STONECREST RD, SUITE 101, SHELBYVILLE, KY 40065-8126
(502) 633-1584
(502) 633-1509
Mailing address
PO BOX 437169, LOUISVILLE, KY 40253-7169
(502) 254-8501
(502) 805-1957
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
08/11/2006
Last updated
08/18/2014
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