Individual
DALTON KENNETH MOLLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3303 S BOND AVE, PORTLAND, OR 97239-4501
(503) 418-3376
Mailing address
3303 S BOND AVE, PORTLAND, OR 97239-4501
(503) 418-3376
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA224657
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/29/2022
Last updated
05/05/2025
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