MEDICARE: DR. KALPANA SHRIPRAKASH TRIVEDI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401411520	VA

General Provider Information

NPI Number	:	1730277963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KALPANA SHRIPRAKASH TRIVEDI DDS

Provider Business Mailing Address
First Line	:	11166 FAIRFAX BLVD
Second Line	:	#400
City	:	FAIRFAX
State	:	VA
Zip	:	22030-5017
Country	:	US
Telephone Number	:	703-691-3015
Fax Number	:	703-691-3016

Provider Business Practice Location Address
First Line	:	11166 FAIRFAX BLVD
Second Line	:	#400
City	:	FAIRFAX
State	:	VA
Zip	:	22030-5017
Country	:	US
Telephone Number	:	703-691-3015
Fax Number	:	703-691-3016

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/09/2011

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