Provider Demographics
NPI:1386758241
Name:FAIRROW, VERAN ANTONITA (DDS, MPH)
Entity type:Individual
Prefix:DR
First Name:VERAN
Middle Name:ANTONITA
Last Name:FAIRROW
Suffix:
Gender:F
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 YORK RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:TN
Mailing Address - Zip Code:37191-9159
Mailing Address - Country:US
Mailing Address - Phone:615-772-3267
Mailing Address - Fax:
Practice Address - Street 1:2245 YORK RD
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:TN
Practice Address - Zip Code:37191-9159
Practice Address - Country:US
Practice Address - Phone:615-772-3267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11218122300000X
TNDS0000005248122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3202696Medicaid