Provider Demographics
NPI:1518033729
Name:OUANO, JOHN P (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:OUANO
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 1:1 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-1662
Mailing Address - Country:US
Mailing Address - Phone:508-393-1223
Mailing Address - Fax:508-473-7914
Practice Address - Street 1:1 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-1662
Practice Address - Country:US
Practice Address - Phone:508-393-1223
Practice Address - Fax:508-473-7914
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA183151223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABLUE CROSSOtherOUX20085
MA16623OtherHARVARD PILGRIM
MA65505OtherFALLON
MA018315OtherTUFTS
MA65505OtherFALLON
MAU90719Medicare UPIN