Individual provider Active NPI

Daniel John Ouellette, DDS

  • General Practice Dentistry
  • Worcester, MA
National Provider Identifier
1558375931
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
16734 Issued in MA
Practice address
62 South Ludlow Street
Worcester, MA 01603-1325
Phone
(508) 757-1131
Fax
(508) 757-6774
NPI assigned
Jul 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 16734 MA Primary

Addresses

Primary practice location

62 South Ludlow Street
Worcester, MA 01603-1325

Mailing address

62 South Ludlow Street
Worcester, MA 01603-1325
Phone (508) 757-1131

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150710001161 MA Order and Referring Only - DentistPractitioner - Dentist 2163734765

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16734MAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Worcester Smile Studio PLLC PastSince Dec 10, 2023 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1558375931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 SOUTH LUDLOW STREET",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016031325",
            "telephone_number": "508-757-1131",
            "fax_number": "508-757-6774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 SOUTH LUDLOW STREET",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016031325",
            "telephone_number": "508-757-1131",
            "fax_number": "508-757-6774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OUELLETTE",
        "first_name": "DANIEL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "16734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.