Healthcare Provider Details

I. General information

NPI: 1033074513
Provider Name (Legal Business Name): MCCAULEY HOMETOWN DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 N JEFFERSON AVE
MOUNT PLEASANT TX
75455-2329
US

IV. Provider business mailing address

1603 N JEFFERSON AVE
MOUNT PLEASANT TX
75455-2329
US

V. Phone/Fax

Practice location:
  • Phone: 903-572-3981
  • Fax: 903-577-0643
Mailing address:
  • Phone: 903-572-3981
  • Fax: 903-577-0643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JORDEN MARK MORTENSEN
Title or Position: OWNER
Credential: DMD
Phone: 512-520-6365