Provider Demographics
NPI:1851518484
Name:OKUBO, BYRON SCOTT (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:SCOTT
Last Name:OKUBO
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BIRCHTREE LN
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4844
Mailing Address - Country:US
Mailing Address - Phone:801-571-3147
Mailing Address - Fax:
Practice Address - Street 1:7396 UNION PARK AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-6700
Practice Address - Country:US
Practice Address - Phone:801-561-9939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT107214-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics