Michael D. Mellum, Dmd PC

NPI #1407062128 in Portland, Oregon

Provider Information

NPI Number: 1407062128
Entity Type: Organization
Organization Name: Michael D. Mellum, Dmd PC
Primary Specialty: Dentist - General Practice
Enumeration Date: May 16, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 8910 N KELLOGG ST
City: Portland
State: Oregon
ZIP Code: 97203-3002
Phone: (503) 286-4492

Authorized Official

Name: DR. MICHAEL DEANE MELLUM, DMD
Title: PRESIDENT
Phone: (503) 286-4492

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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