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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