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General NPI Number Information
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NPI Number | 1053845115
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Entity Type | Organization
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Legal Business Name | DAVID A. MOURITSEN, DDS, MS, PLLC
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Dates
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Enumeration Date | 04/16/2017
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Last Update Date | 04/16/2017
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Provider Practice Location Address
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Address Line | 2211 RAYFORD RD STE. 117
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City | SPRING
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State | TX
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Zip | 77386-1555
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Country | US
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Telephone | 281-367-2211
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Fax |
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Provider Business Mailing Address
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Address Line | 2211 RAYFORD RD STE. 117
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City | SPRING
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State | TX
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Zip | 77386-1555
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Country | US
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Telephone | 281-367-2211
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. DAVID MOURITSEN
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Credential | DDS, MS
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Telephone | 512-879-7471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 25478
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License Number State | TX
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