Healthcare Provider Details

I. General information

NPI: 1578094702
Provider Name (Legal Business Name): NKA HOLDINGS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 S 5600 W
WEST VALLEY CITY UT
84120-1301
US

IV. Provider business mailing address

3552 S 1300 E
SALT LAKE CITY UT
84106-2936
US

V. Phone/Fax

Practice location:
  • Phone: 801-969-1400
  • Fax:
Mailing address:
  • Phone: 801-915-6049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9296076
License Number StateUT

VIII. Authorized Official

Name: DR. NIELSON KIRK ASHTON
Title or Position: SOLE PROPRIETOR
Credential: DMD
Phone: 801-915-6049