Healthcare Provider Details

I. General information

NPI: 1811502883
Provider Name (Legal Business Name): JENNIE LEA NICOLA CALDWELL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIE LEA NICOLA PIROLO

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3348
US

IV. Provider business mailing address

PO BOX 100414
GAINESVILLE FL
32610-0414
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6695
  • Fax: 352-294-5310
Mailing address:
  • Phone: 352-273-6695
  • Fax: 352-294-5310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS105087
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License NumberDTP841
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: