Provider Demographics
NPI:1902326986
Name:NORDQUIST, BROOKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:
Last Name:NORDQUIST
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 ROSEBUD LN
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-5304
Mailing Address - Country:US
Mailing Address - Phone:712-269-7583
Mailing Address - Fax:
Practice Address - Street 1:5050 L ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68117-1329
Practice Address - Country:US
Practice Address - Phone:402-731-5423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7394122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist