Healthcare Provider Details

I. General information

NPI: 1629448170
Provider Name (Legal Business Name): SIMERJEET KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2015
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4099 RIVERDALE RD
RIVERDALE UT
84405-1569
US

IV. Provider business mailing address

4099 RIVERDALE RD
RIVERDALE UT
84405-1569
US

V. Phone/Fax

Practice location:
  • Phone: 385-405-7044
  • Fax:
Mailing address:
  • Phone: 385-405-7044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14288802-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: