Individual
DR. BRIAN JAMES UNDERWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
105 5TH AVE N, STRUM, WI 54770-9252
(715) 695-2918
(715) 695-3852
Mailing address
105 5TH AVE N, P.O. BOX 400, STRUM, WI 54770-9252
(715) 695-2918
(715) 695-3852
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
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
07/23/2006
Last updated
03/11/2008
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