Provider Demographics
NPI:1457332363
Name:MORTENSEN, ANDREW R (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:R
Last Name:MORTENSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2753 KIT FOX RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5262
Mailing Address - Country:US
Mailing Address - Phone:970-449-2389
Mailing Address - Fax:970-484-7711
Practice Address - Street 1:1040 E ELIZABETH ST STE 201
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3951
Practice Address - Country:US
Practice Address - Phone:970-484-7310
Practice Address - Fax:970-484-7711
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD26101223G0001X
CO94001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice