1235363870 NPI number — DR. JEAN A. DOUILLETTE D.D.S.

Table of content: MR. DAMON HOUSTON (NPI 1396361226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235363870 NPI number — DR. JEAN A. DOUILLETTE D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOUILLETTE
Provider First Name:
JEAN
Provider Middle Name:
A.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALLEN
Provider Other First Name:
JEAN
Provider Other Middle Name:
A.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235363870
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 BARROWS ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH ATTLEBORO
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02760
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-695-3719
Provider Business Mailing Address Fax Number:
508-695-0237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 BARROWS ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH ATTLEBORO
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-695-3719
Provider Business Practice Location Address Fax Number:
508-695-0237
Provider Enumeration Date:
05/12/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  17098 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)