WAYNE A MORTENSEN (NPI# 1801023478) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801023478 |
| Entity Type | Individual |
| Full Name | WAYNE A MORTENSEN |
| Credential | DMD |
| Practice Address |
9213 W State St Boise ID 83714-1737 |
| Practice Telephone | 2088533300 |
| Mailing Telephone | 2088533300 |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2018-12-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | D4220 | ID | Dental Providers |
| Y | 1223G0001X |
Dentist Specialization: General Practice |
D-4220 | ID | Dental Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 317 W Cherry Ln, Meridian, ID 836421608 | 2083951000 | 2088950583 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780878314 | Wayne Marcus Mortensen | Radiology | 190 E Bannock St, Boise, ID 83712-6241 | 2007-08-27 |
| 1346256690 | Wayne W Mortensen | Orthopaedic Surgery | 1157 N 300 W, #201, Provo, UT 84604-6124 | 2006-07-31 |
| Street Address |
9213 W STATE ST |
| City | BOISE |
| State | ID |
| Zip Code | 83714-1737 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932683752 | Ikdo State Street LLC | Dentist | 9209 W State St, Garden City, ID 83714 | 2018-09-18 |
| 1437608007 | Carrie Boroughs Breaux | Ophthalmology | 5019 N Sawyer Ave, Garden City, ID 83714 | 2016-09-23 |
| 1841646007 | Alliance Medical Group, LLC | Family Medicine | 5601 W. Chinden Blvd., Garden City, ID 83714 | 2016-05-06 |
| 1134580467 | Rebecca Gillet | Physical Therapist | 6576 W Dufferin Ct, Boise, ID 83714 | 2016-03-15 |
| 1063816007 | Ingri Suzanne Koloski | Counselor | 8969 West Hepburn Lane, Garden City, ID 83714 | 2014-10-20 |
| 1679909329 | Anile Nina | Counselor | 5484 N Gary Lane, Boise, ID 83714 | 2013-09-25 |
| 1215360292 | William Blake Bybee | Dentist | 5833 W. Hidden Springs Dr., Boise, ID 83714 | 2013-08-14 |
| 1871833327 | Charmaine Read | Social Worker | 123 E. 44th St, Ste. A, Garden City, ID 83714 | 2013-02-20 |
| 1811206576 | Bennett Medical Services | Durable Medical Equipment & Medical Supplies | 5220 Sawyer Court, Suite D, Garden City, ID 83714 | 2010-09-29 |
| 1073780680 | Barry Lynn Williams | Pharmacist | 7020 W State Street, Boise, ID 83714 | 2008-05-13 |
| Find all providers in zip 83714 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588273635 | Atlantis Dental Care, P.a. | Dentist | 13238 W Persimmon Ln Ste 100, Boise, ID 83713-1968 | 2020-07-24 |
| 1235747338 | Dentists of Boise and Orthodontics, PC | Dentist | 7500 W State St Ste 110, Boise, ID 83714-6074 | 2020-07-15 |
| 1346895232 | Tejasi Avasare | Dentist | 8321 W Overland Rd, Boise, ID 83709-1640 | 2019-08-07 |
| 1528610359 | Melissa Marie Pysnak | Dentist | 8850 W Emerald St Ste 150, Boise, ID 83704-4809 | 2019-07-11 |
| 1124684584 | Trevor Tafoya Dds Victory Dental, Pllc | Dentist | 7421 W Victory Rd, Boise, ID 83709-5106 | 2019-05-11 |
| 1982260360 | Brant Burbank | Dentist | 4255 N Eagle Rd Ste 102, Boise, ID 83713-0701 | 2019-05-11 |
| 1972023398 | Northview Dental Partnership LLC | Dentist | 7480 W Northview St, Boise, ID 83704-7232 | 2017-06-27 |
| 1962939421 | Travis Jon Weimer | Dentist | 8336 W Northview St, Boise, ID 83704-7132 | 2017-05-16 |
| 1922480284 | Jonathan W Pluid | Dentist | 4274 N Eagle Rd, Boise, ID 83713-0726 | 2015-06-23 |
| 1922489673 | Gray Team LLC | Dentist | 813 N Stilson Rd, Ste:b, Boise, ID 83703-5119 | 2015-06-17 |
| Find all providers in BOISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.