IVAN JOHN KONKIN

PORTLAND, OR
NPI1265067615
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy122400000X Denturist
(Licence: OR  DT-DO-10204635)
Enumeration Date2020-03-05
Last Update Date2020-03-06
Business Address
IVAN JOHN KONKIN
12661 SE POWELL BLVD STE C
PORTLAND, OR 97236-3400
Phone number: 503-655-4007
Mailing Address
IVAN JOHN KONKIN
12661 SE POWELL BLVD STE C
PORTLAND, OR 97236-3400
Phone number: 503-655-4007
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