Healthcare Provider Details

I. General information

NPI: 1205841939
Provider Name (Legal Business Name): DENISE J UNTERBRINK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 DANIELS CREEK RD
COLLINSVILLE VA
24078
US

IV. Provider business mailing address

2200 DANIELS CREEK RD
COLLINSVILLE VA
24078
US

V. Phone/Fax

Practice location:
  • Phone: 276-647-5310
  • Fax: 276-647-4217
Mailing address:
  • Phone: 276-647-5310
  • Fax: 276-647-4217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401006768
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: