Provider Demographics
NPI:1902053978
Name:DAVID L. OUELLETTE D.D.S.
Entity Type:Organization
Organization Name:DAVID L. OUELLETTE D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:OUELLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-847-7999
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR32891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty