Provider Demographics
NPI:1942429147
Name:THOMAS E OUELLETTE DDS PC
Entity Type:Organization
Organization Name:THOMAS E OUELLETTE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:OUELLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-296-1402
Mailing Address - Street 1:1391 SPEER BLVD STE 540
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-2571
Mailing Address - Country:US
Mailing Address - Phone:303-296-1402
Mailing Address - Fax:303-293-8729
Practice Address - Street 1:1391 SPEER BLVD STE 540
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-2571
Practice Address - Country:US
Practice Address - Phone:303-296-1402
Practice Address - Fax:303-293-8729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO006952261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental