Provider Demographics
NPI:1215220843
Name:OUELLETTE, JONATHAN PAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:PAUL
Last Name:OUELLETTE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 LORAINE DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3307
Mailing Address - Country:US
Mailing Address - Phone:407-862-7000
Mailing Address - Fax:407-788-1452
Practice Address - Street 1:210 LORAINE DR
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3307
Practice Address - Country:US
Practice Address - Phone:407-862-7000
Practice Address - Fax:407-788-1452
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20431122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist