Provider Demographics
NPI:1003006024
Name:UNRUH, MARK DARRIN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DARRIN
Last Name:UNRUH
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 1:425 S MADISON BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2826
Mailing Address - Country:US
Mailing Address - Phone:918-333-3628
Mailing Address - Fax:
Practice Address - Street 1:425 S MADISON BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2826
Practice Address - Country:US
Practice Address - Phone:918-333-3628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK53381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics