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General NPI Number Information
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NPI Number | 1841425220
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Entity Type | Individual
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Provider Name | JENNIFER STACEY UNDERWOOD DDS
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Gender | Female
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Dates
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Enumeration Date | 05/28/2009
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Last Update Date | 08/10/2014
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Provider Practice Location Address
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Address Line | 5605 PRINCETON AVE STE B
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City | COLUMBUS
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State | GA
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Zip | 31904-9069
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Country | US
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Telephone | 706-323-8811
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Fax |
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Provider Business Mailing Address
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Address Line | 5605 PRINCETON AVE STE B
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City | COLUMBUS
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State | GA
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Zip | 31904-9069
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Country | US
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Telephone | 706-323-8811
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN013785
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License Number State | GA
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