Desiree Nicole Outlaw, DDS in East Hartford, CT - Medicare Dentist Provider

Desiree Nicole Outlaw, DDS is a medicare enrolled "Dentist" provider in East Hartford, Connecticut. Her current practice location is 94 Connecticut Blvd, East Hartford, Connecticut. You can reach out to her office (for appointments etc.) via phone at (860) 610-6348.

Desiree Nicole Outlaw is licensed to practice in Connecticut (license number 12817) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1538644471.

Contact Information

	Desiree Nicole Outlaw, DDS
	94 Connecticut Blvd, East Hartford, CT 06108-3013
	(860) 610-6348
	Not Available

Healthcare Provider's Profile

Full Name	Desiree Nicole Outlaw
Gender	Female
Speciality	Dentist
Location	94 Connecticut Blvd, East Hartford, Connecticut
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1538644471
Provider Enumeration Date: 09/26/2018
Last Update Date: 07/23/2020

Medicare PECOS Information:

PECOS PAC ID: 3779827712
Enrollment ID: I20181203002115

Medical Identifiers

Medical identifiers for Desiree Nicole Outlaw such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1538644471	NPI	-	NPPES
12817	Other	CT	DENTAL LICENSE

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
1223G0001X	Dentist - General Practice	060129 (New York)	Secondary
122300000X	Dentist	12817 (Connecticut)	Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Desiree Nicole Outlaw is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Desiree Nicole Outlaw, DDS 22 Liberty Sq Apt 381, Bloomfield, CT 06002-5407 Ph: (301) 325-6412	Desiree Nicole Outlaw, DDS 94 Connecticut Blvd, East Hartford, CT 06108-3013 Ph: (860) 610-6348

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Dentist in East Hartford, CT

Dr. Michael Wernick, D.M.D. Dentist Medicare: Not Enrolled in Medicare Practice Location: 170 Main St, East Hartford, CT 06118 Phone: 860-568-3366
Dr. Joanne Jones Mcfee, D.M.D. Dentist Medicare: Not Enrolled in Medicare Practice Location: 763 Burnside Ave, East Hartford, CT 06108 Phone: 860-291-9154
Chiradip Kar, DDS Dentist Medicare: Medicare Enrolled Practice Location: 593 Burnside Ave, East Hartford, CT 06108 Phone: 646-812-2071
Richard P Lasnier, DMD Dentist Medicare: Medicare Enrolled Practice Location: 477 Connecticut Blvd, Suite 201, East Hartford, CT 06108 Phone: 860-289-4080 Fax: 860-289-5400
Dr. Robert Michael Grillo, D.M.D. Dentist Medicare: Medicare Enrolled Practice Location: 47 Burnside Ave, East Hartford, CT 06108 Phone: 860-528-2194 Fax: 860-528-2195
Dr. Jeffrey Dixon, DDS, M.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 477 Connecticut Blvd Ste 105, East Hartford, CT 06108 Phone: 860-289-9397 Fax: 860-528-3129
Dr. Jeffrey D Altman, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 1011 Main St, East Hartford, CT 06108 Phone: 860-528-3350

Desiree Nicole Outlaw, DDS - Medicare Dentist in East Hartford, CT