Individual
DR. JASON PATRICK OUELLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
455 MAGNOLIA AVE STE B, MERRITT ISLAND, FL 32952-4838
(180) 076-7645
Mailing address
1254 GARRISON DR, ST AUGUSTINE, FL 32092-1075
(404) 414-0106
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN014030
GA
122300000X
Dentist
DN19187
FL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN 19187
FL
Other
Enumeration date
02/11/2010
Last updated
09/27/2013
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