MEDICARE: DR. VERAN ANTONITA FAIRROW DDS, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	11218	KY
2	122300000X	Dentist	DS0000005248	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386758241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VERAN ANTONITA FAIRROW DDS, MPH

Provider Business Mailing Address
First Line	:	2245 YORK RD
Second Line	:
City	:	WOODLAWN
State	:	TN
Zip	:	37191-9159
Country	:	US
Telephone Number	:	615-772-3267
Fax Number	:

Provider Business Practice Location Address
First Line	:	2245 YORK RD
Second Line	:
City	:	WOODLAWN
State	:	TN
Zip	:	37191-9159
Country	:	US
Telephone Number	:	615-772-3267
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/24/2024

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