Provider Demographics
NPI:1134117765
Name:UNTERMAN, BRIAN MICHAEL (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MICHAEL
Last Name:UNTERMAN
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Gender:M
Credentials:DDS, MD
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Mailing Address - Street 1:4185 TECHNOLOGY FOREST BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-2006
Mailing Address - Country:US
Mailing Address - Phone:281-296-9562
Mailing Address - Fax:281-296-9774
Practice Address - Street 1:4185 TECHNOLOGY FOREST BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-2006
Practice Address - Country:US
Practice Address - Phone:281-296-9562
Practice Address - Fax:281-296-9774
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX19636204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery