Provider Demographics
NPI:1225765001
Name:DK1 PLLC
Entity Type:Organization
Organization Name:DK1 PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-668-4296
Mailing Address - Street 1:476 W 800 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-3728
Mailing Address - Country:US
Mailing Address - Phone:801-221-7615
Mailing Address - Fax:
Practice Address - Street 1:476 W 800 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-3728
Practice Address - Country:US
Practice Address - Phone:801-221-7615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental