Provider Demographics
NPI:1376634006
Name:OUELLETTE, DAVID L
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:OUELLETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5921 HIGHWAY 5 N
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-8515
Mailing Address - Country:US
Mailing Address - Phone:501-847-7999
Mailing Address - Fax:501-653-0074
Practice Address - Street 1:5921 HIGHWAY 5 N
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-8515
Practice Address - Country:US
Practice Address - Phone:501-847-7999
Practice Address - Fax:501-653-0074
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR32891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice