Provider Demographics
NPI:1770804098
Name:NICHOLSON, JENNA ALEECE (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:ALEECE
Last Name:NICHOLSON
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 1:11225 DECATUR ST #101
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234
Mailing Address - Country:US
Mailing Address - Phone:720-679-9689
Mailing Address - Fax:303-414-1120
Practice Address - Street 1:11225 DECATUR ST #101
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234
Practice Address - Country:US
Practice Address - Phone:720-679-9689
Practice Address - Fax:303-414-1120
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO102111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice