Organization
NICK R. MELLUM DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICK MELLUM DMD (DENTIST)
(503) 286-4492
Entity
Organization
Contact information
Practice address
8910 N KELLOGG ST, PORTLAND, OR 97203-3002
(503) 286-4492
Mailing address
8910 N KELLOGG ST, PORTLAND, OR 97203-3002
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D8836
OR
Other
Enumeration date
03/02/2012
Last updated
03/02/2012
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