Individual
DR. MALIN GRADY FRIESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8916
(503) 494-0294
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8916
(503) 494-0294
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D9065
OR
1223G0001X
General Practice Dentistry
DD3441
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD3441
STATE LICENSE
NM
Enumeration date
10/25/2005
Last updated
03/05/2020
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