Provider Demographics
NPI:1750604450
Name:MORTENSON FAMILY DENTAL CENTER-FRANKFORT, PLLC
Entity type:Organization
Organization Name:MORTENSON FAMILY DENTAL CENTER-FRANKFORT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:REIBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-254-8526
Mailing Address - Street 1:PO BOX 437169
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40253-7169
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1303 US HWY. 127 SOUTH
Practice Address - Street 2:STE 102
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4385
Practice Address - Country:US
Practice Address - Phone:502-223-2266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental