Provider Demographics
NPI:1407443229
Name:SUJAY TRIVEDI DMD PA
Entity Type:Organization
Organization Name:SUJAY TRIVEDI DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIVEDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-805-8875
Mailing Address - Street 1:275 N FEDERAL HWY APT 113
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-4344
Mailing Address - Country:US
Mailing Address - Phone:860-805-8875
Mailing Address - Fax:
Practice Address - Street 1:3111 45TH ST STE 7
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-1981
Practice Address - Country:US
Practice Address - Phone:561-687-0006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty