Provider Demographics
NPI:1043741309
Name:UNRUH PEDIATRIC DENTISTRY LLC
Entity Type:Organization
Organization Name:UNRUH PEDIATRIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:UNRUH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-979-3626
Mailing Address - Street 1:717 N 7 HWY
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2426
Mailing Address - Country:US
Mailing Address - Phone:816-622-2843
Mailing Address - Fax:
Practice Address - Street 1:717 N HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-6426
Practice Address - Country:US
Practice Address - Phone:816-622-2843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160367171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty