Provider Type Icon

BRENT W MORTENSON DMD NPI 1356369169


NPI Information

NPI: 1356369169
Provider Name: BRENT W MORTENSON, DMD
Classification: Dentist - 1223S0112X
Entity Type: Individual

Specialization: Oral and Maxillofacial Surgery

PECOS Registration: Yes

Address:
134 EVERGREEN RD
SUITE 103
LOUISVILLE, KY
ZIP 40243
Phone: (502) 410-1702
Get Directions

Brent W Mortenson, DMD is an oral and maxillofacial surgery dentist in Louisville, KY with 31 years of experience. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. Brent W Mortenson, DMD NPI is 1356369169. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF LOUISVILLE SCHOOL OF DENTISTRY
Graduation Year:1993

The provider's business location address is:

134 EVERGREEN RD
SUITE 103
LOUISVILLE, KY
ZIP 40243-487
Phone: (502) 410-1702
Fax: (502) 244-0817

The NPI 1356369169 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 7/18/2006 and was last updated on 6/18/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1122300000XDentist7229KENTUCKYNo
21223P0221XDentistPediatric Dentistry7229KENTUCKYNo
3204E00000XOral & Maxillofacial Surgery7229KENTUCKYNo
41223S0112XDentistOral and Maxillofacial Surgery7229KENTUCKYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
10574803MEDICARE PINKENTUCKY
20997502MEDICARE PINKENTUCKY
30047405MEDICARE PINKENTUCKY
460072295MEDICAIDKENTUCKY
564072291MEDICAIDKENTUCKY
6U68878MEDICARE UPINKENTUCKY
70047505MEDICARE PINKENTUCKY
80047608MEDICARE PINKENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.