Provider Demographics
NPI:1205131869
Name:DR DAVE L OUELLETTE, DDS, PA
Entity type:Organization
Organization Name:DR DAVE L OUELLETTE, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:L
Authorized Official - Last Name:OUELLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-955-0155
Mailing Address - Street 1:3401 SPRINGHILL DR
Mailing Address - Street 2:SUITE 285
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2924
Mailing Address - Country:US
Mailing Address - Phone:501-955-0155
Mailing Address - Fax:501-955-0159
Practice Address - Street 1:3401 SPRINGHILL DR
Practice Address - Street 2:SUITE 285
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2924
Practice Address - Country:US
Practice Address - Phone:501-955-0155
Practice Address - Fax:501-955-0159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR20321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty