Provider Demographics
NPI:1144204009
Name:OUELLETTE, ALBERT L (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:L
Last Name:OUELLETTE
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 1:11107 SADLER GRV
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-5021
Mailing Address - Country:US
Mailing Address - Phone:210-913-0651
Mailing Address - Fax:
Practice Address - Street 1:11107 SADLER GRV
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-5021
Practice Address - Country:US
Practice Address - Phone:210-913-0651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX296861223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery