Provider Demographics
NPI:1639594484
Name:DERVESH, TRIPTI (DDS)
Entity Type:Individual
Prefix:
First Name:TRIPTI
Middle Name:
Last Name:DERVESH
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 1:1345 E. UNIVERSITY AVENUE
Mailing Address - Street 2:#302
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316
Mailing Address - Country:US
Mailing Address - Phone:515-264-9022
Mailing Address - Fax:515-963-9061
Practice Address - Street 1:1345 E. UNIVERSITY AVENUE
Practice Address - Street 2:#302
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316
Practice Address - Country:US
Practice Address - Phone:515-264-9022
Practice Address - Fax:515-963-9061
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS09032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist