Brent R. Unruh, Dmd, PA
Dentist, Periodontics in Coeur D Alene, ID. Organization (NPI-2).
NPI number1881746048
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1881746048
- Entity type
- Organization (NPI-2)
- Legal business name
- Brent R. Unruh, Dmd, PA
- Organization subpart
- No
- Enumeration date
- Jan 17, 2007
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0300X | Dentist, Periodontics | D-1764 | ID | Yes |
Practice location
1717 Lincoln WaySuite 107
Coeur D Alene, ID 83814-2556
Phone 208-664-0489 · Fax 208-769-7339
Mailing address
1717 Lincoln WaySuite 107
Coeur D Alene, ID 83814-2556
Phone 208-664-0489 · Fax 208-769-7339
Authorized official
Brent Unruh
President
2086640489
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