Individual provider Active NPI

Simerjeet Kaur

  • Dentist
  • Riverdale, UT
National Provider Identifier
1629448170
Registry record updated Jul 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
14288802-9926 Issued in UT
Practice address
4099 Riverdale Rd
Riverdale, UT 84405-1569
Phone
(385) 405-7044
NPI assigned
Sep 28, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 2, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 14288802-9926 UT Primary

Addresses

Primary practice location

4099 Riverdale Rd
Riverdale, UT 84405-1569

Mailing address

4099 Riverdale Rd
Riverdale, UT 84405-1569
Phone (385) 405-7044

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151210000739 WI Order and Referring Only - DentistPractitioner - Dentist 6507167806

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1001211WIMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Familia Dental Green Bay East LLC CurrentSince Jun 27, 2021 Accepting new patients
Familia Dental Mkemitchell LLC Past Accepting new patients
Mr. Teeth PLLC Past Accepting new patients

Locations

2050 E Algonquin Rd
Ste 610
Schaumburg, IL 60173
Phone (847) 701-1457

1931 Main St
Green Bay, WI 54302
Phone (833) 225-0853

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1443398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782950400000",
    "number": "1629448170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4099 RIVERDALE RD",
            "city": "RIVERDALE",
            "state": "UT",
            "postal_code": "844051569",
            "telephone_number": "385-405-7044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4099 RIVERDALE RD",
            "city": "RIVERDALE",
            "state": "UT",
            "postal_code": "844051569",
            "telephone_number": "385-405-7044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAUR",
        "first_name": "SIMERJEET",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-28",
        "last_updated": "2026-07-02",
        "certification_date": "2026-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "14288802-9926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverdale, UT

Sources for this page

Verify at the official NPI Registry.