Mortenson, Brent W

Mortenson, Brent W is an individual health care provider with primary practice located at 134 Evergreen Rd Suite 103, Louisville KY 40243-1487. He recently has 4 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / Pediatric Dentistry, Dental Providers / Oral and Maxillofacial Surgery, Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery. Dental Providers / Oral and Maxillofacial Surgery is his primary health care specialty. Mortenson, Brent W can be contacted via phone (502) 410-1702.

Contact Information

Primary practice address
134 Evergreen Rd Suite 103 Louisville KY 40243-1487
Phone: (502) 410-1702
Fax: (502) 244-0817
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 7229 Kentucky
Dental Providers / Pediatric Dentistry 1223P0221X 7229 Kentucky
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 7229 Kentucky
Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery 204E00000X 7229 Kentucky

Profile Details

NPI number 1356369169
LBN Legal business name Mortenson, Brent W
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 18th, 2006
Last updated Jun 18th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356369169 NPPES
Kentucky MEDICAID 64072291
Kentucky MEDICAID 60072295

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