Provider Demographics
NPI:1720119639
Name:MORTMAN, RORY E (DDS)
Entity Type:Individual
Prefix:DR
First Name:RORY
Middle Name:E
Last Name:MORTMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 PRESIDENTIAL WAY
Mailing Address - Street 2:STE #7
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-1800
Mailing Address - Country:US
Mailing Address - Phone:561-684-1312
Mailing Address - Fax:561-684-0182
Practice Address - Street 1:1501 PRESIDENTIAL WAY
Practice Address - Street 2:STE #7
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-1800
Practice Address - Country:US
Practice Address - Phone:561-684-1312
Practice Address - Fax:561-684-0182
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL138461223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics