Active NPI
Jason Patrick Ouellette, D.D.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Merritt Island, FL
National Provider Identifier
1891027181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- DN 19187
- Practice address
- 455 Magnolia Ave Ste B
Merritt Island, FL 32952-4838 - Phone
- (180) 076-7645
- NPI assigned
- Feb 11, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN19187 | FL | |
| Dentist | 122300000X | DN014030 | GA | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | DN 19187 | FL | Primary |
Addresses
Primary practice location
455 Magnolia Ave Ste B
Merritt Island, FL 32952-4838
Mailing address
1254 Garrison Dr
St Augustine, FL 32092-1075
Phone (404) 414-0106
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN19187 | FL | MD | Dentist |
| DN014030 | GA | MD | Dentist |
| DN 19187 | FL | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Affordable Braces of North Florida | Orthodontics and Dentofacial Orthopedics | Past | 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.
-
- Orthodontics and Dentofacial Orthopedics Dentistry
- St Augustine, FL
- NPI 1538533674
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265846400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380240000000",
"number": "1891027181",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1254 GARRISON DR",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320921075",
"telephone_number": "404-414-0106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "455 MAGNOLIA AVE STE B",
"city": "MERRITT ISLAND",
"state": "FL",
"postal_code": "329524838",
"telephone_number": "180-076-7645"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OUELLETTE",
"first_name": "JASON",
"middle_name": "PATRICK",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-02-11",
"last_updated": "2013-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN19187",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "DN014030",
"primary": false
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "FL",
"license": "DN 19187",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Merritt Island, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.