Provider Demographics
NPI:1669103164
Name:BHAGWAGAR, MICHELE SHIRAZ (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:SHIRAZ
Last Name:BHAGWAGAR
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 LINGLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3631
Mailing Address - Country:US
Mailing Address - Phone:717-652-3887
Mailing Address - Fax:
Practice Address - Street 1:3825 LINGLESTOWN RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3631
Practice Address - Country:US
Practice Address - Phone:717-652-3887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859581122300000X
PADS0452951223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist