Konkin, Ivan John

Konkin, Ivan John is an sole proprietor health care provider with primary practice located at 12661 Se Powell Blvd Ste C , Portland OR 97236-3400. He recently has only one registered license in Dental Providers / Denturist, which is considered as his primary health care specialty. Konkin, Ivan John can be contacted via phone (503) 655-4007.

Contact Information

Primary practice address
12661 Se Powell Blvd Ste C Portland OR 97236-3400
Phone: (503) 655-4007
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Denturist 122400000X DT-DO-10204635 Oregon

Profile Details

NPI number 1265067615
LBN Legal business name Konkin, Ivan John
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 5th, 2020
Last updated Mar 6th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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