Provider Demographics
NPI:1730277963
Name:TRIVEDI, KALPANA SHRIPRAKASH (DDS)
Entity type:Individual
Prefix:DR
First Name:KALPANA
Middle Name:SHRIPRAKASH
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:11166 FAIRFAX BLVD
Mailing Address - Street 2:#400
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5017
Mailing Address - Country:US
Mailing Address - Phone:703-691-3015
Mailing Address - Fax:703-691-3016
Practice Address - Street 1:11166 FAIRFAX BLVD
Practice Address - Street 2:#400
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5017
Practice Address - Country:US
Practice Address - Phone:703-691-3015
Practice Address - Fax:703-691-3016
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2011-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA04014115201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice