Provider Demographics
NPI:1508886201
Name:NICOLETTE, JEANNE MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARIE
Last Name:NICOLETTE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7814 CALVERTON SQ
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-9340
Mailing Address - Country:US
Mailing Address - Phone:614-855-5025
Mailing Address - Fax:
Practice Address - Street 1:2862 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-3709
Practice Address - Country:US
Practice Address - Phone:614-235-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH158311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice