Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ivan John Konkin

Individual provider Denturist · NPI 1265067615

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 C
Portland, OR 97236-3400
Phone: (503) 655-4007
Show map & directions

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 number1265067615
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMarch 5, 2020
Last updated in NPPESMarch 6, 2020
Certification dateMarch 6, 2020
Mailing address12661 Se Powell Blvd Ste C, Portland, OR 97236-3400

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