Provider Demographics
NPI:1578094702
Name:NKA HOLDINGS PLLC
Entity Type:Organization
Organization Name:NKA HOLDINGS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NIELSON
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:ASHTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-915-6049
Mailing Address - Street 1:3552 S 1300 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2936
Mailing Address - Country:US
Mailing Address - Phone:801-915-6049
Mailing Address - Fax:
Practice Address - Street 1:3451 S 5600 W
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-1301
Practice Address - Country:US
Practice Address - Phone:801-969-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9296076122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1023421740Medicaid