Reggie H. Broom, D.M.D., P.A.

LBN: Reggie H. Broom, D.M.D., P.A.
Reggie H. Broom, D.M.D., P.A. is an health care organization with primary practice located at 1635 E Pass Rd , Gulfport MS 39507-3527. The organization recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as the primary health care specialty. Reggie H. Broom, D.M.D., P.A. can be contacted via phone (228) 896-5197, or through Broom, Reggie Harris via phone (228) 896-5197.

Contact Information

Primary practice address
1635 E Pass Rd Gulfport MS 39507-3527
Phone: (228) 896-5197
Fax: (228) 896-5192
Website:
Map and Directions
Authorized official contact:
Name: Broom, Reggie Harris Doctor of Dental Medicine (DMD)
Phone: (228) 896-5197

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Pediatric Dentistry 1223P0221X 2005-83 Mississippi

Profile Details

NPI number 1215280672
LBN Legal business name Reggie H. Broom, D.M.D., P.A.
DBA Doing business as
Authorized official Broom, Reggie Harris Doctor of Dental Medicine (DMD)
Entity Organization
Organization subpart 1 No
Enumeration date Oct 23rd, 2012
Last updated Oct 23rd, 2012 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215280672 NPPES
Mississippi MEDICAID 09015230
Mississippi Other 466176
Mississippi MEDICAID 07734393

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