Provider Demographics
NPI:1306657077
Name:UNRUH, BRACE DOUGLAS (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:BRACE
Middle Name:DOUGLAS
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:918-331-9141
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:918-331-9141
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7974122300000X
OK2741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist