Provider Demographics
NPI:1861726978
Name:MORTENSEN, AARON D (DMD)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:D
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 1:1750 MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3211
Mailing Address - Country:US
Mailing Address - Phone:303-678-7783
Mailing Address - Fax:303-532-2287
Practice Address - Street 1:1750 MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3211
Practice Address - Country:US
Practice Address - Phone:303-678-7783
Practice Address - Fax:303-532-2287
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9994122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist