Provider Demographics
NPI:1396727830
Name:TRIVEDI, JAYESH H (DDS)
Entity type:Individual
Prefix:DR
First Name:JAYESH
Middle Name:H
Last Name:TRIVEDI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13404 ROCKAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11420-3021
Mailing Address - Country:US
Mailing Address - Phone:718-529-3300
Mailing Address - Fax:718-529-9043
Practice Address - Street 1:13406 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11420-3021
Practice Address - Country:US
Practice Address - Phone:718-529-3300
Practice Address - Fax:718-529-9043
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0320501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00294179Medicaid