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General NPI Number Information
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NPI Number | 1437329901
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Entity Type | Organization
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Legal Business Name | DR. BRIAN J. UNDERWOOD, D.D.S., S.C.
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 105 5TH AVE N
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City | STRUM
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State | WI
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Zip | 54770-9252
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Country | US
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Telephone | 715-695-2918
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Fax | 715-695-3852
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Provider Business Mailing Address
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Address Line | 105 5TH AVE N PO BOX 400
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City | STRUM
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State | WI
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Zip | 54770-9252
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Country | US
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Telephone | 715-695-2918
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Fax | 715-695-3852
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN JAMES UNDERWOOD
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Credential | DDS
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Telephone | 715-695-2918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 3750
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License Number State | WI
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