MEDICARE: SMILES FOR EWA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1841145307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILES FOR EWA LLC

Provider Business Mailing Address
First Line	:	91-1123 KEAUNUI DR STE 232
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-6370
Country	:	US
Telephone Number	:	808-354-0808
Fax Number	:

Provider Business Practice Location Address
First Line	:	91-1123 KEAUNUI DR STE 232
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-6370
Country	:	US
Telephone Number	:	808-354-0808
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. BROOKE UPERESA
Credential	:	DDS
Telephone Number	:	808-354-0808

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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