Healthcare Provider Details

I. General information

NPI: 1285156604
Provider Name (Legal Business Name): DANIELLE OUTLAW DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE LAUREN OUTLAW-PETERSON DDS

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 B Y WILLIAMS SR DR
MIDFIELD AL
35228-2218
US

IV. Provider business mailing address

101 GREYSTONE GLEN DR
BIRMINGHAM AL
35242-7105
US

V. Phone/Fax

Practice location:
  • Phone: 205-923-3172
  • Fax:
Mailing address:
  • Phone: 409-719-6852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12339
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD-0006995-C1
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: