Provider Demographics
NPI:1265925853
Name:BROEKEMIER, NOLAND WILLIAM (DDS)
Entity type:Individual
Prefix:
First Name:NOLAND
Middle Name:WILLIAM
Last Name:BROEKEMIER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3157 FARNAM ST APT 7618
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-3548
Mailing Address - Country:US
Mailing Address - Phone:308-940-2821
Mailing Address - Fax:
Practice Address - Street 1:11110 FORT ST STE 106
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-2183
Practice Address - Country:US
Practice Address - Phone:402-492-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7467122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEH13204619OtherDRIVER'S LICENSE