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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