Brian James Underwood, D.D.S.
Individual provider Active NPI General Practice Dentistry · Strum, WI
NPI 1972524908 · NPPES record last updated Mar 11, 2008
Key facts
- NPI
- 1972524908
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 3750 (WI)
- Practice address
- 105 5TH Ave N
Strum, WI 54770-9252 - Phone
- (715) 695-2918
- Fax
- (715) 695-3852
- NPI assigned
- Jul 23, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160415000018 | WI | Order and Referring Only - Oral Surgery |
4880585413 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3750 | WI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr. Brian J. Underwood, D.D.S., S.C. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3750 | WI | Yes |
Addresses
Primary practice location
105 5TH Ave N
Strum, WI 54770-9252
Mailing address
105 5TH Ave N
P.O. Box 400
Strum, WI 54770-9252
Phone (715) 695-2918
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33693400 | Medicaid | WI | |
| 391675083011 | Other | BLUE CROSS BLUE SHIELD | |
| 391675083001 | Other | DELTA DENTAL |
Other providers in Strum, WI
- Natural Health Chiropractic Center, Inc.
- Molly Nicolet
- Jessa Payne
- Nichole Roemhild
- Strum Residence LLC
All providers in Strum, WI · General Practice Dentistry in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 11, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.