institution
Reggie H. Broom, D.m.d., P.a.
Pediatric Dentist in Gulfport, Mississippi
NPI 1215280672

Reggie H. Broom, D.m.d., P.a. is a Pediatric Dentist based in Gulfport, MS and is specialized in Pediatric Dentistry. Reggie H. Broom, D.m.d., P.a. practices in Gulfport, MS. The NPI Number for Reggie H. Broom, D.m.d., P.a. is 1215280672 and holds a License No. 2005-83 (Mississippi).

The current practice location address for Reggie H. Broom, D.m.d., P.a. is 1635 E Pass Rd, Gulfport, MS and can be reached out via phone at 228-896-5197 and via fax at 228-896-5192. You can also correspond with Reggie H. Broom, D.m.d., P.a. through the mailing address at 1635 E PASS RD, GULFPORT, MS - 39507-3527 (mailing address contact number: 228-896-5197).

Location: 1635 E Pass Rd, Gulfport, MS, 39507-3527
institution
Provider Profile Details
NPI Number
1215280672
Provider Name
Reggie H. Broom, D.m.d., P.a.
Credential
Provider Entity Type
Organization
Address
1635 E Pass Rd, Gulfport, MS, 39507-3527
Phone Number
228-896-5197
Fax Number
228-896-5192
Provider Enumeration Date
10/23/2012
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
09015230 05 MS
466176 01 MS UNITED CONCORDIA
07734393 05 MS
institution
Provider Business Practice Location Address Details
Address
1635 E Pass Rd
City
State
Zip
39507-3527
Phone Number
228-896-5197
Fax Number
228-896-5192
person
Provider Business Mailing Address Details
Address
1635 E Pass Rd
City
State
Zip
39507-3527
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.
2005-83 (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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