Provider Demographics
NPI:1346681244
Name:OKUBO, MIRANDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:
Last Name:OKUBO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7369 S CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6154
Mailing Address - Country:US
Mailing Address - Phone:801-566-5577
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:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT89605139923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist