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General NPI Number Information
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NPI Number | 1265801294
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Entity Type | Individual
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Provider Name | MEHULKUMAR TRIVEDI DMD
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Gender | Male
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Dates
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Enumeration Date | 09/21/2015
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 733 OAKWOOD DR
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City | FENTON
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State | MO
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Zip | 63026-3535
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Country | US
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Telephone | 636-349-1070
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Fax |
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Provider Business Mailing Address
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Address Line | 1331 SEABURY CIR
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City | CAROL STREAM
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State | IL
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Zip | 60188-4823
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Country | US
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Telephone | 630-903-5952
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS040732
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901021704
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN21503
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1002243
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.030588
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2024005484
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License Number State | MO
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