| Derek W. Conklin Dmd Pc | |
|
17471 Shelley Ave Ste A Sandy OR 97055-8084 | |
| (503) 668-4655 | |
| (503) 668-8755 |
| Full Name | Derek W. Conklin Dmd Pc |
|---|---|
| Speciality | Dentist |
| Location | 17471 Shelley Ave Ste A, Sandy, Oregon |
| Authorized Official Name and Position | Derek W. Conklin (PRESIDENT) |
| Authorized Official Contact | 5036684655 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Derek W. Conklin Dmd Pc 17471 Shelley Ave Ste A Sandy OR 97055-8084 Ph: (503) 668-4655 | Derek W. Conklin Dmd Pc 17471 Shelley Ave Ste A Sandy OR 97055-8084 Ph: (503) 668-4655 |
| NPI Number | 1558635391 |
|---|---|
| Provider Enumeration Date | 02/24/2012 |
| Last Update Date | 02/24/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558635391 | NPI | - | NPPES |
| 243185 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D8325 (Oregon) | Primary |
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