Provider Demographics
NPI:1518180132
Name:BROKENSHIRE, ANN ERIN (DMD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:ERIN
Last Name:BROKENSHIRE
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 1:811 BLOOM ROAD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-1217
Mailing Address - Country:US
Mailing Address - Phone:570-275-1451
Mailing Address - Fax:570-271-1533
Practice Address - Street 1:811 BLOOM ROAD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-1217
Practice Address - Country:US
Practice Address - Phone:570-275-1451
Practice Address - Fax:570-271-1533
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028552L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice