Provider Demographics
NPI:1932391281
Name:MCCONKIE, DANIEL R
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:MCCONKIE
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:DAN
Other - Middle Name:
Other - Last Name:MCCONKIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:539 N HARRISVILLE RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:HARRISVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84404-3560
Mailing Address - Country:US
Mailing Address - Phone:801-786-0700
Mailing Address - Fax:
Practice Address - Street 1:539 N HARRISVILLE RD
Practice Address - Street 2:SUITE F
Practice Address - City:HARRISVILLE
Practice Address - State:UT
Practice Address - Zip Code:84404-3560
Practice Address - Country:US
Practice Address - Phone:801-786-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5167801-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice