NPI 1063588788

Reggie Harris Broom, DMD

Practitioner Pediatric Dentistry Gulfport, MS

Practice location

Address: 1635 E Pass Road, Gulfport, MS 39507
Phone: (228) 896-5197
Fax: (228) 896-5192

Registered specialties (2)

Pediatric Dentistry Primary

Dental Providers Taxonomy 1223P0221X Licence 200583 (MS)

Other Dentist providers in Mississippi →

Pediatric Dentistry

Dental Providers Taxonomy 1223P0221X Licence 11986 (MS)

Registry record

NPI: 1063588788
Entity type: Individual
Sex (as registered): Male
NPI issued: 27 Nov 2006
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.