Healthcare Provider Details

I. General information

NPI: 1508916867
Provider Name (Legal Business Name): SHAWN F. UNDERWOOD D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18425 CHAMPION FOREST DR # 250
SPRING TX
77379-3999
US

IV. Provider business mailing address

18425 CHAMPION FOREST DR # 250
SPRING TX
77379-3999
US

V. Phone/Fax

Practice location:
  • Phone: 281-655-5400
  • Fax: 281-655-4571
Mailing address:
  • Phone: 281-655-5400
  • Fax: 281-655-4571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number20029
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: