MEDICARE: DR. SAMIRA AHMED HEEREN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN31900	FL

General Provider Information

NPI Number	:	1578498465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMIRA AHMED HEEREN DDS

Provider Business Mailing Address
First Line	:	5285 SUMMERLIN RD STE 401
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-7601
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5285 SUMMERLIN RD STE 401
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-7601
Country	:	US
Telephone Number	:	239-313-7770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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