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IVAN JOHN KONKIN
NPI 1265067615
Denturist in Portland, OR

Active since March 05, 2020
12661 SE POWELL BLVD STE C, PORTLAND, OR 97236(503) 655-4007 Get Directions Write a Review

NPPES record last updated: March 6, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Ivan John Konkin NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IVAN JOHN KONKIN (NPI 1265067615) is an individual denturist in Portland, Oregon, licensed in Oregon (DT-DO-10204635) and active in the NPI registry since March 2020.

NPPES Registry Identity

NPI1265067615
Entity TypeIndividualMale
Primary Taxonomy122400000X
Provider Legal NameIVAN JOHN KONKIN
Location Address12661 SE POWELL BLVD STE CPortland, OR 97236-3400
Mailing Address12661 Se Powell Blvd Ste CPortland, OR 97236-3400 · (503) 655-4007
Phone(503) 655-4007
Sole ProprietorYes
Enumeration DateMarch 5, 2020
Last NPPES UpdateMarch 6, 2020
NPPES CertifiedMarch 6, 2020
✔ NPI 1265067615 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDenturistDental Providers
Taxonomy Code122400000X
License✔ Licensed in OR · DT-DO-10204635
Definition
A denturist is a licensed professional that serves patients with removable dental prosthetic oral health needs. A licensed denturist is trained in removable dental prosthetics and the fabrication of such devices.
12661 SE POWELL BLVD STE C, Portland, OR 97236
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MASTER DENTAL SMILES INC
Dentist (General Practice)
12661 SE POWELL BLVD STE C
PORTLAND, OR 97236
Multnomah County (503) 761-1900
SMILECRAFT DENTURES LLC
Denturist
12661 SE POWELL BLVD STE C
PORTLAND, OR 97236
Multnomah County (503) 380-7306

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ivan Konkin's NPI number?

The NPI number for Ivan Konkin is 1265067615. It was assigned to this individual provider in the NPPES registry on March 5, 2020.

Where is Ivan Konkin located?

Ivan Konkin practices at 12661 SE Powell Blvd Ste C, Portland, OR 97236. The listed phone number is (503) 655-4007.

What is Ivan Konkin's specialty?

The primary specialty registered for this NPI is Denturist with taxonomy code 122400000X.

When was this NPI record last updated?

The NPPES record for Ivan Konkin was last updated on March 6, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.