Provider Demographics
NPI:1699385062
Name:TRIVEDI, HETAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:HETAL
Middle Name:
Last Name:TRIVEDI
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 1:930 SPRING ST NW UNIT 915-A
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3816
Mailing Address - Country:US
Mailing Address - Phone:415-488-5502
Mailing Address - Fax:
Practice Address - Street 1:930 SPRING ST NW UNIT 915-A
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3816
Practice Address - Country:US
Practice Address - Phone:415-488-5502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1050511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice