Nelson Paez Carrillo, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN30329 Issued in FL

Practice address

2710 Blanding Blvd Ste 3
Middleburg, FL 32068-5650

Phone

(904) 637-1148

Fax

(904) 302-9392

NPI assigned

Jun 3, 2025

Last updated

Jun 3, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1748908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748908800000",
    "number": "1790678134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 TECHNOLOGY PARK STE 101",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327467122",
            "telephone_number": "407-543-8514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2710 BLANDING BLVD STE 3",
            "city": "MIDDLEBURG",
            "state": "FL",
            "postal_code": "320685650",
            "telephone_number": "904-637-1148",
            "fax_number": "904-302-9392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAEZ CARRILLO",
        "first_name": "NELSON",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-06-03",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN30329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary O'Hara
• Shanelle Oliver, RN
• Optimal Holistic Medicine
• Optimal Homecare Services LLC
• Orange Park Medical Center, Inc. (HCA Florida Middleburg Emergency, a department of HCA Florida Orange Park Hospital)
• Lisa H Page, LMHC
• Keri Lynn Parker, RBT
• Stephanie Parks, ARNP
• Rukma Parthvi, MD
• Kathryn Pasos, M.S., CCC-SLP

• General Practice Dentistry in Middleburg, FL
• Providers in Middleburg, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.