Nick R. Mellum DMD PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D8836 Issued in OR

Legal business name

NICK R. MELLUM DMD PC

Practice address

8910 N Kellogg St
Portland, OR 97203-3002

Phone

(503) 286-4492

NPI assigned

Mar 2, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Nick Mellum, DMD

Title

Dentist

Phone

(503) 286-4492

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael D. Mellum, D.M.D.

  • General Practice Dentistry
  • Portland, OR
  • NPI 1861481848
  NPD (past)
• Nicholas Ryan Mellum, DMD

  • General Practice Dentistry
  • Portland, OR
  • NPI 1053454173
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1330646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330646400000",
    "number": "1013281484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8910 N KELLOGG ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972033002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8910 N KELLOGG ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972033002",
            "telephone_number": "503-286-4492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICK R. MELLUM DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-02",
        "last_updated": "2012-03-02",
        "status": "A",
        "authorized_official_last_name": "MELLUM",
        "authorized_official_first_name": "NICK",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "503-286-4492",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D8836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Lynn Nicholson, N.D.
• Robert Stokes Nicholson, RN
• Syrena Nicholson, LMT
• Todd L. Nicholson, M.S.
• Valerie Nicholson
• Jordan Taylor Nickel-Dubin, MA
• Jeffrey Charles Nickel, DMD MSC PHD
• Rachel Nickel, MSW, LICSW
• Jereme Dawn Nickell, OT
• Joshua Phillip Nickelsen

• General Practice Dentistry in Portland, OR
• Providers in Portland, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.