Reggie Harris Broom
Pediatric Dentist
1635 E Pass Road
Gulfport
, Mississippi 39507
Reggie Harris Broom
Pediatric Dentist
1635 E Pass Road
Gulfport
, Mississippi 39507
(228) 896-5192
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About
Features
Specialties
- Pediatric Dentist
Languages spoken
- English
Location
First Address
- Reggie Harris Broom
- 1635 E Pass Road
- Gulfport, MS
- Zip : 39507
- Fax : (228) 896-5192
- Phone : (228) 896-5197
Second Address
- Reggie Harris Broom
- 1635 E Pass Road
- Gulfport, MS
- Zip : 39507
- Fax : (228) 896-5192
- Phone : (228) 896-5197
Reviews
FAQs
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What type of doctor is Reggie Harris Broom
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Where is Reggie Harris Broom ’s practice located?
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Is Reggie Harris Broom a sole practitioner?
Is Reggie Harris Broom accepting new patients?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 1223P0221X | Pediatric Dentist | 11986 | MS |
| Y | 1223P0221X | Pediatric Dentist | 200583 | MS |
National Provider Identifier
| NPI | 1063588788 |
|---|---|
| Provider Name | Reggie Harris Broom |
| First Address | Gulfport, MS 39507 |
| Second Address | Gulfport, MS 39507 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 27/11/2006 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| H66176 | UNITED CONCORDIA (01) | MS |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.