Broom, Reggie Harris

Broom, Reggie Harris is an individual health care provider with primary practice located at 1635 E Pass Road , Gulfport MS 39507. He recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as his primary health care specialty. Broom, Reggie Harris can be contacted via phone (228) 896-5197.

Contact Information

Primary practice address
1635 E Pass Road Gulfport MS 39507
Phone: (228) 896-5197
Fax: (228) 896-5192
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Pediatric Dentistry 1223P0221X 200583 Mississippi
Dental Providers / Pediatric Dentistry 1223P0221X 11986 Mississippi

Profile Details

NPI number 1063588788
LBN Legal business name Broom, Reggie Harris
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 27th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1063588788 NPPES
Mississippi Other H66176 UNITED CONCORDIA

Popular Providers