Healthcare Provider Details

I. General information

NPI: 1487013298
Provider Name (Legal Business Name): ROBERT T UNDERWOOD DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 MOUNT OLIVE RD
GARDENDALE AL
35071-3443
US

IV. Provider business mailing address

1038 MOUNT OLIVE RD
GARDENDALE AL
35071-3443
US

V. Phone/Fax

Practice location:
  • Phone: 205-631-8066
  • Fax: 205-631-8021
Mailing address:
  • Phone: 205-631-8066
  • Fax: 205-631-8021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4885
License Number StateAL

VIII. Authorized Official

Name: DR. ROBERT UNDERWOOD
Title or Position: OWNER
Credential:
Phone: 205-631-8066