=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306744800
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VERIDIAN SMILES ORTHODONTICS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2026
-----------------------------------------------------
Last Update Date | 11/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3612 ERIE AVE
-----------------------------------------------------
City | SHEBOYGAN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53081-3666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-457-2267
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2309 BRIAN CT
-----------------------------------------------------
City | WAUKESHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53188-2029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-593-8784
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORTHODONTIST
-----------------------------------------------------
Name | DR. CAROLYN WHITTOW
-----------------------------------------------------
Credential | DMD, MS
-----------------------------------------------------
Telephone | 864-593-8784
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------