Provider Demographics
NPI:1841371929
Name:UNDERWOOD, ROBERT TERRELL (DMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:TERRELL
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 MT. OLIVE ROAD
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-3443
Mailing Address - Country:US
Mailing Address - Phone:205-631-8066
Mailing Address - Fax:205-631-8021
Practice Address - Street 1:1038 MT. OLIVE ROAD
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-3443
Practice Address - Country:US
Practice Address - Phone:205-631-8066
Practice Address - Fax:205-631-8021
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL48851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51096265OtherBLUE CROSS BLUE SHIELD
AL51096265OtherBLUE CROSS BLUE SHIELD