Provider Demographics
NPI:1972944692
Name:TRIVEDI, HETALBAHEN P (DMD)
Entity Type:Individual
Prefix:DR
First Name:HETALBAHEN
Middle Name:P
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10115 SW NIMBUS AVE
Mailing Address - Street 2:STE 350
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-4330
Mailing Address - Country:US
Mailing Address - Phone:503-684-7868
Mailing Address - Fax:
Practice Address - Street 1:1001 SE TUALATIN VALLEY HWY
Practice Address - Street 2:A-16
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-5097
Practice Address - Country:US
Practice Address - Phone:503-693-1217
Practice Address - Fax:503-693-1137
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2016-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD98931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice