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Reggie Harris Broom, DMD
Pediatric Dentist in Gulfport, Mississippi
NPI 1063588788

Reggie Harris Broom is a Pediatric Dentist based in Gulfport, MS and is specialized in Pediatric Dentistry. Reggie Harris Broom practices in Gulfport, MS and has the professional credentials of DMD. The NPI Number for Reggie Harris Broom is 1063588788 and holds a License No. 200583 (Mississippi).

The current practice location address for Reggie Harris Broom is 1635 E Pass Road, Gulfport, MS and can be reached out via phone at 228-896-5197 and via fax at 228-896-5192.

Location: 1635 E Pass Road, Gulfport, MS, 39507
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Provider Profile Details
NPI Number
1063588788
Provider Name
Reggie Harris Broom
Credential
DMD
Provider Entity Type
Individual
Gender
Male
Address
1635 E Pass Road, Gulfport, MS, 39507
Phone Number
228-896-5197
Fax Number
228-896-5192
Provider Enumeration Date
11/27/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
H66176 01 MS UNITED CONCORDIA
institution
Provider Business Practice Location Address Details
Address
1635 E Pass Road
City
State
Zip
39507
Phone Number
228-896-5197
Fax Number
228-896-5192
person
Provider Business Mailing Address Details
Address
1635 E Pass Road
City
State
Zip
39507
Phone Number
228-896-5197
Fax Number
228-896-5192
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Pediatric Dentistry
Taxonomy
License No.
200583 (Mississippi)
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
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