Healthcare Provider Details

I. General information

NPI: 1285462994
Provider Name (Legal Business Name): SIMREN BAGRI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9503 NE 2ND AVE
MIAMI SHORES FL
33138-2704
US

IV. Provider business mailing address

16723 FALCONHURST DR
PURCELLVILLE VA
20132-9650
US

V. Phone/Fax

Practice location:
  • Phone: 786-310-4816
  • Fax:
Mailing address:
  • Phone: 571-335-9966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number29415
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4727
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: