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General NPI Number Information
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NPI Number | 1508242827
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Entity Type | Organization
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Legal Business Name | MORTENSON FAMILY DENTAL CENTER - LAWRENCEBURG LLC
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Dates
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Enumeration Date | 08/10/2015
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Last Update Date | 08/10/2015
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Provider Practice Location Address
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Address Line | 1019 WEST EADS PARKWAY US 50
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City | LAWRENCEBURG
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State | IN
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Zip | 47102-1842
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Country | US
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Telephone | 502-254-8500
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Fax | 502-805-1957
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Provider Business Mailing Address
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Address Line | 1019 WEST EADS PARKWAY US 50
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City | LAWRENCEBURG
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State | IN
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Zip | 47102-1842
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Country | US
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Telephone | 502-254-8500
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Fax | 502-805-1957
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Authorized Official
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Title or Position | CFO
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Name | STEPHEN JAMES
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Credential |
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Telephone | 502-254-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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