Provider Demographics
NPI:1437047644
Name:VANTOORENBURG, BROOKE (DMD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:VANTOORENBURG
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 1:974 E 2100 S APT 210
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-4529
Mailing Address - Country:US
Mailing Address - Phone:813-466-8699
Mailing Address - Fax:
Practice Address - Street 1:263 COUNTRY CLUB DR STE 103
Practice Address - Street 2:
Practice Address - City:STANSBURY PARK
Practice Address - State:UT
Practice Address - Zip Code:84074-9602
Practice Address - Country:US
Practice Address - Phone:435-210-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14223912122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist