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:
Health care specialties
| Specialty | Code | License # | 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 4 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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