person
Ivan John Konkin
Denturist in Portland, Oregon
NPI 1265067615

Ivan John Konkin is a Denturist based in Portland, OR. Ivan John Konkin practices in Portland, OR. The NPI Number for Ivan John Konkin is 1265067615 and holds a License No. DT-DO-10204635 (Oregon).

The current practice location address for Ivan John Konkin is 12661 Se Powell Blvd Ste C, Portland, OR and can be reached out via phone at 503-655-4007.

Location: 12661 Se Powell Blvd Ste C, Portland, OR, 97236-3400
person
Provider Profile Details
NPI Number
1265067615
Provider Name
Ivan John Konkin
Credential
Provider Entity Type
Individual
Gender
Male
Address
12661 Se Powell Blvd Ste C, Portland, OR, 97236-3400
Phone Number
503-655-4007
Fax Number
Provider Enumeration Date
03/05/2020
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
12661 Se Powell Blvd Ste C
City
State
Zip
97236-3400
Phone Number
503-655-4007
Fax Number
person
Provider Business Mailing Address Details
Address
12661 Se Powell Blvd Ste C
City
State
Zip
97236-3400
Phone Number
503-655-4007
Fax Number
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Denturist
Speciality
-
Taxonomy
License No.
DT-DO-10204635 (Oregon)
Definition
Definition to come.
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