Provider Demographics
NPI:1811502883
Name:CALDWELL, JENNIE LEA NICOLA (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:LEA NICOLA
Last Name:CALDWELL
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:LEA NICOLA
Other - Last Name:PIROLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 100414
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0414
Mailing Address - Country:US
Mailing Address - Phone:352-273-6695
Mailing Address - Fax:352-294-5310
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3348
Practice Address - Country:US
Practice Address - Phone:352-273-6695
Practice Address - Fax:352-294-5310
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS105087122300000X
FLDTP8411223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
No122300000XDental ProvidersDentist