Provider Demographics
NPI:1023153020
Name:DERROW, CAROLINE WEISSMAN (DDS)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:WEISSMAN
Last Name:DERROW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 NICHOLAS ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-3635
Mailing Address - Country:US
Mailing Address - Phone:260-927-0707
Mailing Address - Fax:260-927-0808
Practice Address - Street 1:1005 NICHOLAS ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-3635
Practice Address - Country:US
Practice Address - Phone:260-927-7070
Practice Address - Fax:260-927-0808
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010667A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200839880 AMedicaid