Provider Demographics
NPI:1326114133
Name:UNDERWOOD, ALFRED H JR
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:H
Last Name:UNDERWOOD
Suffix:JR
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 1:1399 NW 17 AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2334
Mailing Address - Country:US
Mailing Address - Phone:305-325-0050
Mailing Address - Fax:305-325-0935
Practice Address - Street 1:1399 NW 17 AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2334
Practice Address - Country:US
Practice Address - Phone:305-325-0050
Practice Address - Fax:305-325-0935
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 26281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice