NPIMap

Organization Active NPI

Dr. Brian J. Underwood, D.D.S., S.C.

  • Dental Clinic/Center
  • Strum, WI
National Provider Identifier
1437329901
Registry record updated Jun 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
3750 Issued in WI
Legal business name
DR. BRIAN J. UNDERWOOD, D.D.S., S.C.
Practice address
105 5TH Ave N
Strum, WI 54770-9252
Phone
(715) 695-2918
Fax
(715) 695-3852
NPI assigned
Mar 11, 2008
Last updated
Jun 12, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brian James Underwood, DDSNPI 1972524908
Title
Owner
Phone
(715) 695-2918

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 3750 WI Primary

Addresses

Primary practice location

105 5TH Ave N
Strum, WI 54770-9252

Mailing address

105 5TH Ave N
PO Box 400
Strum, WI 54770-9252
Phone (715) 695-2918

Other identifiers 3

IdentifierTypeStateIssuer
33693400MedicaidWI
391675083011OtherBLUE CROSS BLUE SHIELD
391675083001OtherDELTA DENTAL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213228800000",
    "number": "1437329901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 5TH AVE N",
            "address_2": "PO BOX 400",
            "city": "STRUM",
            "state": "WI",
            "postal_code": "547709252",
            "telephone_number": "715-695-2918",
            "fax_number": "715-695-3852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 5TH AVE N",
            "city": "STRUM",
            "state": "WI",
            "postal_code": "547709252",
            "telephone_number": "715-695-2918",
            "fax_number": "715-695-3852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. BRIAN J. UNDERWOOD, D.D.S., S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-11",
        "last_updated": "2008-06-12",
        "status": "A",
        "authorized_official_last_name": "UNDERWOOD",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-695-2918",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WI",
            "license": "3750",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33693400",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "391675083011",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL",
            "identifier": "391675083001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Strum, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.