Provider Demographics
NPI:1679142053
Name:TRIVEDI, VIDHI MANOJ (DMD)
Entity type:Individual
Prefix:DR
First Name:VIDHI
Middle Name:MANOJ
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 PLAINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:STIRLING
Mailing Address - State:NJ
Mailing Address - Zip Code:07980-1514
Mailing Address - Country:US
Mailing Address - Phone:908-240-2494
Mailing Address - Fax:
Practice Address - Street 1:3108 S 31ST ST STE 3108
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1803
Practice Address - Country:US
Practice Address - Phone:254-742-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37327122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist