Organization
MICHAEL D. MELLUM, DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL DEANE MELLUM DMD (PRESIDENT)
(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
(503) 286-4492
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/16/2007
Last updated
08/22/2020
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