Provider Demographics
NPI:1104305861
Name:CHAMBERLAIN, BROOKE NICOLE (DMD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:NICOLE
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8073 W 51ST PL BLDG 4-304
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-4352
Mailing Address - Country:US
Mailing Address - Phone:618-562-7607
Mailing Address - Fax:
Practice Address - Street 1:7025 SHERIDAN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80003-3814
Practice Address - Country:US
Practice Address - Phone:618-562-7607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00203719122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist