Provider Demographics
NPI:1578798955
Name:UNDERWOOD, ASHLEY NOEL (BA, DMD, MSD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NOEL
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:BA, DMD, MSD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:NOEL
Other - Last Name:KILLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, DMD, MSD
Mailing Address - Street 1:2519 E KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4719
Mailing Address - Country:US
Mailing Address - Phone:303-819-6200
Mailing Address - Fax:
Practice Address - Street 1:8550 W 38TH AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4300
Practice Address - Country:US
Practice Address - Phone:303-467-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CO103891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO81227078Medicaid