Provider Demographics
NPI:1235818378
Name:LIFESMILES, PLLC
Entity Type:Organization
Organization Name:LIFESMILES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:SHIRLENE
Authorized Official - Last Name:OKUBO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, FAGD
Authorized Official - Phone:801-916-2779
Mailing Address - Street 1:10638 S CARRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-4949
Mailing Address - Country:US
Mailing Address - Phone:801-916-2779
Mailing Address - Fax:
Practice Address - Street 1:7369 S CREEK RD
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-6154
Practice Address - Country:US
Practice Address - Phone:801-566-5577
Practice Address - Fax:801-566-4848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental