Provider Demographics
NPI:1285156604
Name:OUTLAW, DANIELLE (DDS)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:OUTLAW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:LAUREN
Other - Last Name:OUTLAW-PETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:101 GREYSTONE GLEN DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7105
Mailing Address - Country:US
Mailing Address - Phone:409-719-6852
Mailing Address - Fax:
Practice Address - Street 1:111 B Y WILLIAMS SR DR
Practice Address - Street 2:
Practice Address - City:MIDFIELD
Practice Address - State:AL
Practice Address - Zip Code:35228-2218
Practice Address - Country:US
Practice Address - Phone:205-923-3172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12339122300000X
ALD-0006995-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist