Provider Demographics
NPI:1750126983
Name:NICHOLSON, PAIGE JEANETTE (DMD)
Entity type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:JEANETTE
Last Name:NICHOLSON
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 1:7380 SW 13TH RD UNIT 324
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-3573
Mailing Address - Country:US
Mailing Address - Phone:352-664-9374
Mailing Address - Fax:
Practice Address - Street 1:9120 NW 36TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7340
Practice Address - Country:US
Practice Address - Phone:352-575-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL292421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice