Provider Demographics
NPI:1023858446
Name:BROEKING, SHELBI (DMD)
Entity type:Individual
Prefix:
First Name:SHELBI
Middle Name:
Last Name:BROEKING
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 1:217 LAMOND RUELLE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-9717
Mailing Address - Country:US
Mailing Address - Phone:859-771-1924
Mailing Address - Fax:
Practice Address - Street 1:3695 STAR RANCH RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-5980
Practice Address - Country:US
Practice Address - Phone:719-597-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program