| Mortimer Family Dentistry, Pc | |
|
4495 S Center Rd Burton MI 48519-1417 | |
| (810) 743-5131 | |
| (810) 743-1111 |
| Full Name | Mortimer Family Dentistry, Pc |
|---|---|
| Speciality | Dentist |
| Location | 4495 S Center Rd, Burton, Michigan |
| Authorized Official Name and Position | Scott Allen Mortimer (PRESIDENT) |
| Authorized Official Contact | 8107435131 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mortimer Family Dentistry, Pc 4495 S Center Rd Burton MI 48519-1417 Ph: (810) 743-5131 | Mortimer Family Dentistry, Pc 4495 S Center Rd Burton MI 48519-1417 Ph: (810) 743-5131 |
| NPI Number | 1417121732 |
|---|---|
| Provider Enumeration Date | 04/17/2008 |
| Last Update Date | 07/15/2015 |
| Medicare PECOS PAC ID | 2163616913 |
|---|---|
| Medicare Enrollment ID | O20101105000177 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417121732 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2901014445 (Michigan) | Primary |
| Provider Name | Scott A Mortimer |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1861439978 PECOS PAC ID: 4082672183 Enrollment ID: I20041221000455 |
| Provider Name | Allen Wayne Mortimer |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1972867851 PECOS PAC ID: 3173742293 Enrollment ID: I20140922001729 |
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