Provider Demographics
NPI:1952426108
Name:MORTIMER, ROBERT R (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:MORTIMER
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 1:5290 LOGAN FERRY RD
Mailing Address - Street 2:STE D
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668
Mailing Address - Country:US
Mailing Address - Phone:724-733-2211
Mailing Address - Fax:724-327-4730
Practice Address - Street 1:5290 LOGAN FERRY RD
Practice Address - Street 2:STE D
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668
Practice Address - Country:US
Practice Address - Phone:724-733-2211
Practice Address - Fax:724-327-4730
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025767L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics