Individual
DR. NICHOLAS RYAN MELLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
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
(503) 286-4492
(503) 765-1343
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D8836
OR
Other
Enumeration date
02/15/2007
Last updated
05/10/2016
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