Provider Demographics
NPI:1841874088
Name:TRIVEDI, PULIN (DMD)
Entity type:Individual
Prefix:DR
First Name:PULIN
Middle Name:
Last Name:TRIVEDI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10432 S JORDAN GTWY UNIT 3309
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-5418
Mailing Address - Country:US
Mailing Address - Phone:858-603-8172
Mailing Address - Fax:
Practice Address - Street 1:181 N 1200 E
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2446
Practice Address - Country:US
Practice Address - Phone:801-855-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12271440-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist