MEDICARE: DR. BRUCE ROLAND OUELLETTE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	9470	FL

General Provider Information

NPI Number	:	1174681613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE ROLAND OUELLETTE D.D.S.

Provider Business Mailing Address
First Line	:	2431 S DIXIE HWY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-7935
Country	:	US
Telephone Number	:	561-659-5566
Fax Number	:

Provider Business Practice Location Address
First Line	:	2431 S DIXIE HWY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-7935
Country	:	US
Telephone Number	:	561-659-5566
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	01/24/2012

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