REGGIE HARRIS BROOM DMD NPI 1063588788

NPI Information

NPI: 1063588788
Provider Name: REGGIE HARRIS BROOM, DMD
Classification: Dentist - 1223P0221X
Entity Type: Individual

Specialization: Pediatric Dentistry

Address:
1635 E PASS ROAD
GULFPORT, MS
ZIP 39507
Phone: (228) 896-5197
Get Directions

Reggie Harris Broom, DMD is a pediatric dentistry dentist in Gulfport, MS. The provider is 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. Reggie Harris Broom, DMD NPI is 1063588788. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1635 E PASS ROAD
GULFPORT, MS
ZIP 39507
Phone: (228) 896-5197
Fax: (228) 896-5192

The enumeration date for this NPI number is 11/27/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223P0221X	Dentist	Pediatric Dentistry	11986	MISSISSIPPI	No
2	1223P0221X	Dentist	Pediatric Dentistry	200583	MISSISSIPPI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	H66176	OTHER	MISSISSIPPI	UNITED CONCORDIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »