Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 040428 | PA |
N | 122300000X | Dentist | 09184 | IA |
Y | 1223G0001X | General Practice | 27219 | TX |
Y | 213EG0000X | General Practice | 27219 | TX |
NPI | 1003104886 |
---|---|
Provider Name | Amar Trivedi |
First Address | Fresno, TX 77545 |
Second Address | Fresno, TX 77545-6070 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2011 |
Last Update Date | 15/06/2015 |