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Organization
DEREK W. CONKLIN DMD PC
Active
Organization
DEREK W. CONKLIN DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEREK W. CONKLIN DMD (PRESIDENT)
(503) 668-4655
Entity
Organization
Contact information
Practice address
17471 SHELLEY AVE STE A, SANDY, OR 97055-8084
(503) 668-4655
(503) 668-8755
Mailing address
17471 SHELLEY AVE STE A, SANDY, OR 97055-8084
(503) 668-4655
(503) 668-8755
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D8325
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
243185
—
OR
Enumeration date
02/24/2012
Last updated
02/24/2012
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