MEDICARE: JAY P MALMQUIST DMD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1043159924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAY P MALMQUIST DMD PC

Provider Business Mailing Address
First Line	:	1750 S HARBOR WAY STE 100
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97201-5133
Country	:	US
Telephone Number	:	503-292-8824
Fax Number	:	503-297-7810

Provider Business Practice Location Address
First Line	:	1750 S HARBOR WAY STE 100
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97201-5133
Country	:	US
Telephone Number	:	503-292-8824
Fax Number	:	503-297-7810

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL PRESTON MALMQUIST
Credential	:	DMD
Telephone Number	:	503-292-8824

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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