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Individual
KELLY ANN UNDERWOOD
Active
Individual
KELLY ANN UNDERWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
8450
KY
1223G0001X
General Practice Dentistry
Primary
8450
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100002330
—
KY
01
—
7100219740
KY MEDICAID EPSDT
KY
05
—
7100219740
—
KY
Enumeration date
03/26/2007
Last updated
10/23/2013
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