Provider Demographics
NPI:1629056775
Name:NICOLETTE, SCOTT JONATHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JONATHAN
Last Name:NICOLETTE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5109 W BROAD ST
Mailing Address - Street 2:202
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1648
Mailing Address - Country:US
Mailing Address - Phone:614-878-2273
Mailing Address - Fax:614-878-0958
Practice Address - Street 1:5109 W BROAD ST
Practice Address - Street 2:202
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1648
Practice Address - Country:US
Practice Address - Phone:614-878-2273
Practice Address - Fax:614-878-0958
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH220641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice