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General NPI Number Information
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NPI Number | 1831707132
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Entity Type | Individual
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Provider Name | PRIYANKA TRIVEDI DMD
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Gender | Female
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Dates
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Enumeration Date | 07/22/2020
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Last Update Date | 10/07/2021
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Provider Practice Location Address
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Address Line | 11585 US HIGHWAY 14
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City | WOODSTOCK
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State | IL
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Zip | 60098-7227
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Country | US
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Telephone | 815-269-4681
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Fax |
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Provider Business Mailing Address
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Address Line | 550 E IL ROUTE 173
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City | ANTIOCH
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State | IL
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Zip | 60002-9420
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Country | US
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Telephone | 847-603-3069
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.033309
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License Number State | IL
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