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Organization
DR. BRIAN J. UNDERWOOD, D.D.S., S.C.
Active
Organization
DR. BRIAN J. UNDERWOOD, D.D.S., S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN JAMES UNDERWOOD DDS (OWNER)
(715) 695-2918
Entity
Organization
Contact information
Practice address
105 5TH AVE N, STRUM, WI 54770-9252
(715) 695-2918
(715) 695-3852
Mailing address
105 5TH AVE N, PO BOX 400, STRUM, WI 54770-9252
(715) 695-2918
(715) 695-3852
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
3750
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33693400
—
WI
01
—
391675083001
DELTA DENTAL
—
01
—
391675083011
BLUE CROSS BLUE SHIELD
—
Enumeration date
03/11/2008
Last updated
06/12/2008
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