Provider Demographics
NPI:1114931326
Name:UNDERWOOD, KENT M
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:M
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7630 SAWMILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9606
Mailing Address - Country:US
Mailing Address - Phone:614-761-9777
Mailing Address - Fax:614-761-9934
Practice Address - Street 1:7630 SAWMILL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9606
Practice Address - Country:US
Practice Address - Phone:614-761-9777
Practice Address - Fax:614-761-9934
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300208051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics