Healthcare Provider Details

I. General information

NPI: 1548265614
Provider Name (Legal Business Name): JAMES FRANKLIN OUTLAW DDS1
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/18/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

2550 ALOMA AVE
WINTER PARK FL
32792-3402
US

IV. Provider business mailing address

2550 ALOMA AVE
WINTER PARK FL
32792-3402
US

V. Phone/Fax

Practice location:
  • Phone: 407-671-6506
  • Fax: 407-671-0782
Mailing address:
  • Phone: 407-671-6506
  • Fax: 407-671-0782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8945
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: