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General NPI Number Information
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NPI Number | 1811502883
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Entity Type | Individual
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Provider Name | JENNIE LEA NICOLA CALDWELL DDS
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Gender | Female
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 1600 SW ARCHER RD
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City | GAINESVILLE
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State | FL
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Zip | 32610-3348
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Country | US
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Telephone | 352-273-6695
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Fax | 352-294-5310
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Provider Business Mailing Address
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Address Line | PO BOX 100414
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City | GAINESVILLE
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State | FL
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Zip | 32610-0414
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Country | US
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Telephone | 352-273-6695
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Fax | 352-294-5310
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DDS105087
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223X0008X
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Taxonomy Name | Oral and Maxillofacial Radiology Dentistry
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License Number | DTP841
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License Number State | FL
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