Provider Demographics
NPI:1700867769
Name:UNDERWOOD, THOMAS SHAPPLEY (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:SHAPPLEY
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4219 HILLSBORO RD
Mailing Address - Street 2:STE 105
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-3328
Mailing Address - Country:US
Mailing Address - Phone:615-383-5366
Mailing Address - Fax:615-386-3360
Practice Address - Street 1:4219 HILLSBORO RD
Practice Address - Street 2:STE 105
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-3328
Practice Address - Country:US
Practice Address - Phone:615-383-5366
Practice Address - Fax:615-386-3360
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS21931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice