Provider Demographics
NPI:1740288596
Name:OUELLETTE, THOMAS ERIC (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ERIC
Last Name:OUELLETTE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist