Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 5338 | OK |
NPI | 1003006024 |
---|---|
Provider Name | Dr. Mark Darrin Unruh |
First Address | Bartlesville, OK 74006-2826 |
Second Address | Bartlesville, OK 74006-2826 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2007 |
Last Update Date | 26/07/2007 |