Individual
DR. DEREK CONKLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
17471 SHELLEY AVE STE A, SANDY, OR 97055-8084
(503) 668-4655
(503) 668-8755
Mailing address
17471 SHELLEY AVE, 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
04/09/2007
Last updated
02/28/2012
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