Healthcare Provider Details

I. General information

NPI: 1104305861
Provider Name (Legal Business Name): BROOKE NICOLE CHAMBERLAIN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WASHINGTON AVE STE 1
GOLDEN CO
80401-1959
US

IV. Provider business mailing address

7049 PARFET CT
ARVADA CO
80004-1349
US

V. Phone/Fax

Practice location:
  • Phone: 303-279-6621
  • Fax:
Mailing address:
  • Phone: 618-562-7607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00203719
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: