Provider Demographics
NPI:1770746737
Name:UNRUH, BENJAMIN PATRICK (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:PATRICK
Last Name:UNRUH
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 1:909 WALNUT ST APT 605
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64106-2002
Mailing Address - Country:US
Mailing Address - Phone:785-979-3626
Mailing Address - Fax:
Practice Address - Street 1:717 N 7 HWY
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2426
Practice Address - Country:US
Practice Address - Phone:816-622-2843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK62491223G0001X
KS605731223G0001X
MO20160367171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200312950BMedicaid
KS200566550AMedicaid
MO4090189305Medicaid