| Reggie H. Broom, D.m.d., P.a. | |
|
1635 E Pass Rd Gulfport MS 39507-3527 | |
| (228) 896-5197 | |
| (228) 896-5192 |
| Full Name | Reggie H. Broom, D.m.d., P.a. |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1635 E Pass Rd, Gulfport, Mississippi |
| Authorized Official Name and Position | Reggie Harris Broom (PEDIATRIC DENTIST/OWNER) |
| Authorized Official Contact | 2288965197 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Reggie H. Broom, D.m.d., P.a. 1635 E Pass Rd Gulfport MS 39507-3527 Ph: (228) 896-5197 | Reggie H. Broom, D.m.d., P.a. 1635 E Pass Rd Gulfport MS 39507-3527 Ph: (228) 896-5197 |
| NPI Number | 1215280672 |
|---|---|
| Provider Enumeration Date | 10/23/2012 |
| Last Update Date | 10/23/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215280672 | NPI | - | NPPES |
| 09015230 | Medicaid | MS | |
| 466176 | Other | MS | UNITED CONCORDIA |
| 07734393 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 2005-83 (Mississippi) | Primary |
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