Ivan John Konkin
Ivan John Konkin is a Denturist in Portland, Oregon. Practices as a sole proprietor. Licensed in Oregon.
- Licensed in
- OR
- In the registry since
- 2020
Practice location Address checks out
12661 SE Powell Blvd Ste CPortland, OR 97236-3400
Phone: (503) 655-4007
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Denturist (primary) | Taxonomy 122400000X · Licence DT-DO-10204635 (OR) |
|---|
Record details
| NPI number | 1265067615 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | Yes |
| NPI enumerated | March 5, 2020 |
| Last updated in NPPES | March 6, 2020 |
| Certification date | March 6, 2020 |
| Mailing address | 12661 Se Powell Blvd Ste C, Portland, OR 97236-3400 |
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