Provider Demographics
NPI:1265801294
Name:TRIVEDI, MEHULKUMAR (DMD)
Entity type:Individual
Prefix:
First Name:MEHULKUMAR
Middle Name:
Last Name:TRIVEDI
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 SEABURY CIR
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-4823
Mailing Address - Country:US
Mailing Address - Phone:630-903-5952
Mailing Address - Fax:
Practice Address - Street 1:733 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-3535
Practice Address - Country:US
Practice Address - Phone:636-349-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040732122300000X
MI2901021704122300000X
FLDN21503122300000X
WI1002243122300000X
IL019.0305881223G0001X
MO2024005484122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice