Provider Demographics
NPI:1194610386
Name:COLTRANE, BROOKE ALEXANDRA (DDS)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALEXANDRA
Last Name:COLTRANE
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 1:14716 E 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-7005
Mailing Address - Country:US
Mailing Address - Phone:316-734-2456
Mailing Address - Fax:
Practice Address - Street 1:13121 E 21ST ST N STE 107
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67230-7403
Practice Address - Country:US
Practice Address - Phone:316-630-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS623261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice