Individual
DR. JASON LANIER OUTLAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, DMSC
Contact information
Practice address
1575 BLUE HILL AVE, BOSTON, MA 02126-2122
(617) 296-0061
Mailing address
25 DORCHESTER AVE, #51237, BOSTON, MA 02205
(312) 731-5818
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN1858198
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/26/2017
Last updated
05/06/2020
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