Healthcare Provider Details

I. General information

NPI: 1144019274
Provider Name (Legal Business Name): BLAKE UNSELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 07/07/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E OKLAHOMA AVE
GUTHRIE OK
73044-3242
US

IV. Provider business mailing address

8901 OAKMONT VALLEY DR
OKLAHOMA CITY OK
73131-7256
US

V. Phone/Fax

Practice location:
  • Phone: 405-293-4743
  • Fax:
Mailing address:
  • Phone: 405-626-5166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8090
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: