Active NPI
Desiree Nicole Outlaw, DDS
- Dentist
- East Hartford, CT
National Provider Identifier
1538644471
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12817
- Practice address
- 94 Connecticut Blvd
East Hartford, CT 06108-3013 - Phone
- (860) 610-6348
- NPI assigned
- Sep 26, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 060129 | NY | |
| Dentist | 122300000X | 12817 | CT | Primary |
Addresses
Primary practice location
94 Connecticut Blvd
East Hartford, CT 06108-3013
Mailing address
22 Liberty SQ Apt 381
Bloomfield, CT 06002-5407
Phone (301) 325-6412
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12817 | Other | CT | DENTAL LICENSE |
Other names 1
- Desiree Nicole Bryant
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | doutlaw@firstchc.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12817 | CT | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595462400000",
"number": "1538644471",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 LIBERTY SQ APT 381",
"city": "BLOOMFIELD",
"state": "CT",
"postal_code": "060025407",
"telephone_number": "301-325-6412"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "94 CONNECTICUT BLVD",
"city": "EAST HARTFORD",
"state": "CT",
"postal_code": "061083013",
"telephone_number": "860-610-6348"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OUTLAW",
"first_name": "DESIREE",
"middle_name": "NICOLE",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-26",
"last_updated": "2020-07-23",
"certification_date": "2020-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "060129",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CT",
"license": "12817",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE",
"identifier": "12817",
"state": "CT"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "doutlaw@firstchc.org",
"affiliation": "N",
"endpointDescription": "work email",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "work email",
"address_1": "94 Connecticut Blvd",
"city": "East Hartford",
"state": "CT",
"country_code": "US",
"postal_code": "061083013",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "DESIREE",
"last_name": "BRYANT",
"middle_name": "NICOLE",
"credential": "DDS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in East Hartford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.