MEDICARE: LIFESMILES, PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1235818378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESMILES, PLLC

Provider Business Mailing Address
First Line	:	10638 S CARRINGTON ST
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84094-4949
Country	:	US
Telephone Number	:	801-916-2779
Fax Number	:

Provider Business Practice Location Address
First Line	:	7369 S CREEK RD
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-6154
Country	:	US
Telephone Number	:	801-566-5577
Fax Number	:	801-566-4848

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. MIRANDA SHIRLENE OKUBO
Credential	:	DDS, FAGD
Telephone Number	:	801-916-2779

Provider Enumeration Date	:	07/17/2023
Last Update Date	:	07/17/2023

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Directions to “LIFESMILES, PLLC ” Practice Location

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