Provider Demographics
NPI:1285462994
Name:BAGRI, SIMREN (DDS)
Entity type:Individual
Prefix:
First Name:SIMREN
Middle Name:
Last Name:BAGRI
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 1:16723 FALCONHURST DR
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-9650
Mailing Address - Country:US
Mailing Address - Phone:571-335-9966
Mailing Address - Fax:
Practice Address - Street 1:14679 APPLE HARVEST DR STE 100
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3703
Practice Address - Country:US
Practice Address - Phone:304-707-9674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29415122300000X
WV4727122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist