Provider Demographics
NPI:1952566762
Name:JEAN-PHILIPPE, NICOULY PIERRE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICOULY
Middle Name:PIERRE
Last Name:JEAN-PHILIPPE
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 1:6003 SILVER STAR RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-8220
Mailing Address - Country:US
Mailing Address - Phone:407-295-0444
Mailing Address - Fax:407-295-1707
Practice Address - Street 1:6003 SILVER STAR RD
Practice Address - Street 2:SUITE #
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-8220
Practice Address - Country:US
Practice Address - Phone:407-295-0444
Practice Address - Fax:407-295-1707
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL160981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice