| Organization Name: | MORTENSON FAMILY DENTAL CENTER-ELIZABETHTOWN,PLLC |
| NPI Number: | 1033374228 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEVE C JAMES (COO) |
| Mailing Address: | 2407 Ring Rd Suite 137 Elizabethtown |
| State: | KY US |
| Postal Code: | 427015937 |
| Phone Number: | 2703600480 |
| Fax Number: | 2703600490 |
| NPI Enumeration Date: | 07/28/2008 |
| NPI Last Update Date: | 08/06/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |