Outlaw, Desiree Nicole

Outlaw, Desiree Nicole is an individual health care provider with primary practice located at 94 Connecticut Blvd , East Hartford CT 06108-3013. She recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Dentist. Dental Providers / Dentist is her primary health care specialty. Outlaw, Desiree Nicole can be contacted via phone (860) 610-6348.

Contact Information

Primary practice address
94 Connecticut Blvd East Hartford CT 06108-3013
Phone: (860) 610-6348
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 060129 New York
Dental Providers / Dentist 122300000X 12817 Connecticut

Profile Details

NPI number 1538644471
LBN Legal business name Outlaw, Desiree Nicole
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 26th, 2018
Last updated Jul 23rd, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538644471 NPPES
Connecticut Other 12817 DENTAL LICENSE

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