Provider Demographics
NPI:1508916867
Name:UNDERWOOD, SHAWN F (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:F
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18425 CHAMPION FOREST DR
Mailing Address - Street 2:# 250
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3999
Mailing Address - Country:US
Mailing Address - Phone:281-655-5400
Mailing Address - Fax:281-655-4571
Practice Address - Street 1:18425 CHAMPION FOREST DR
Practice Address - Street 2:# 250
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3999
Practice Address - Country:US
Practice Address - Phone:281-655-5400
Practice Address - Fax:281-655-4571
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics