Provider Demographics
NPI:1255958559
Name:MORTENSON, KATE LINDSEY (DMD)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:LINDSEY
Last Name:MORTENSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 HYCLIFFE AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3714
Mailing Address - Country:US
Mailing Address - Phone:859-533-5022
Mailing Address - Fax:
Practice Address - Street 1:3701 HOPEWELL RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-5392
Practice Address - Country:US
Practice Address - Phone:859-533-5022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10448122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist