Healthcare Provider Details

I. General information

NPI: 1750126983
Provider Name (Legal Business Name): PAIGE JEANETTE NICHOLSON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR # D1-19
GAINESVILLE FL
32610-7340
US

IV. Provider business mailing address

2337 SW ARCHER RD APT 3018
GAINESVILLE FL
32608-1015
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-7954
  • Fax:
Mailing address:
  • Phone: 352-664-9374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDN29242
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: