REGGIE H. BROOM, D.M.D., P.A. (NPI# 1215280672) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215280672 |
| Entity Type | Organization |
| Organization Name | REGGIE H. BROOM, D.M.D., P.A. |
| Practice Address |
1635 E Pass Rd Gulfport MS 39507-3527 |
| Practice Telephone | 2288965197 |
| Practice Fax Number | 2288965192 |
| Mailing Telephone | 2288965197 |
| Mailing Fax Number | 2288965192 |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2012-10-23 |
| Authorized Official Name | DR. REGGIE HARRIS BROOM (PEDIATRIC DENTIST/OWNER) |
| Authorized Official Telephone | 2288965197 |
| Authorized Official Credential | D.M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
2005-83 | MS | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 07734393 | 05 | |
| MS | UNITED CONCORDIA | 466176 | 01 |
| MS | 09015230 | 05 |
| Street Address |
1635 E PASS RD |
| City | GULFPORT |
| State | MS |
| Zip Code | 39507-3527 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093262974 | Coastkids Pediatric Dentistry, Pllc | Dentist | 1635 E Pass Rd, Gulfport, MS 39507-3527 | 2016-09-08 |
| 1821409871 | Kristen Mullins Douglas | Dentist | 1635 E Pass Rd, Gulfport, MS 39507-3527 | 2014-05-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609389105 | Karen R Burns | Speech-Language Pathologist | 3506 Washington Avenue, Ste E, Gulfport, MS 39507 | 2017-11-07 |
| 1538605027 | Andrea Broussard | Personal Emergency Response Attendant | 406 Pass Rd, Gulfport, MS 39507 | 2017-01-09 |
| 1366872491 | William Alexis Marcia | Pharmacist | 1444 East Pass Road, Gulfport, MS 39507 | 2013-11-27 |
| 1740599380 | Advanced Hearing Systems, Inc. | Hearing Instrument Specialist | 401 Security Square, Gulfport, MS 39507 | 2010-09-30 |
| 1497068118 | Stacey Ritter Carter | Dentist | 1635 East Pass Road, Gulfport, MS 39507 | 2010-07-22 |
| 1477789964 | Letonoff Orthopaedics & Sports | Orthopaedic Surgery | 452 Court House Road, Suite G, Gulfport, MS 39507 | 2009-06-10 |
| 1730385139 | Bernard Frederick Podlin | Dentist | 400 Pass Road, Gulfport, MS 39507 | 2007-06-22 |
| 1043422553 | Mark D Stringer | Dentist | 520-a Courthouse Road, Gulfport, MS 39507 | 2007-05-04 |
| 1154543528 | Pass Road Elementary | Registered Nurse | 37 Pass Road, Gulfport, MS 39507 | 2007-05-03 |
| 1417073768 | John Hough Hopkins | Dentist | 3303 A Ave, Gulfport, MS 39507 | 2007-03-21 |
| Find all providers in zip 39507 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| 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. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710327960 | Maegen Calhoun Mccabe | Dentist | 11280 E Taylor Rd, Suite B, Gulfport, MS 39503-4038 | 2013-07-02 |
| 1194004994 | Eric L. Hyde, Dds, Pllc | Dentist | 15236 Dedeaux Rd, Gulfport, MS 39503-3161 | 2011-08-10 |
| 1790851707 | Raymond Kimble Doty Jr. | Dentist | 1119 42nd Ave, Gulfport, MS 39501-2664 | 2006-11-28 |
| 1063588788 | Reggie Harris Broom | Dentist | 1635 E Pass Road, Gulfport, MS 39507 | 2006-11-27 |
| 1609888197 | Eric L Hyde | Dentist | 15487 Oak Ln, Suite 200e, Gulfport, MS 39503-2664 | 2006-08-12 |
| 1093262974 | Coastkids Pediatric Dentistry, Pllc | Dentist | 1635 E Pass Rd, Gulfport, MS 39507-3527 | 2016-09-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164938650 | Pediatric Dentistry of Corinth | Dentist | 1500 N Harper Rd #5, Pediatric Dentistry of Corinth, Corinth, MS 38834 | 2017-12-19 |
| 1669837910 | Laurel Dental Properties | Dentist | 1925 Pine Belt Drive, Laurel, MS 39440 | 2015-12-30 |
| 1669850004 | Jcc, LLC | Dentist | 1150 Monteith Avenue, Suite 102, Hernando, MS 38632 | 2015-05-18 |
| 1871971101 | Katherine Curtis Windham | Dentist | 300 Hospital Dr Ste 3, Columbus, MS 39705-1921 | 2015-05-06 |
| 1740673797 | Emilee Peeples Milling | Dentist | 1855 Crane Ridge Dr Ste 2, Jackson, MS 39216-4944 | 2015-03-16 |
| 1114359866 | Cmhp Enterprises | Dentist | 1420 Wooded Drive, Grenada, MS 38901 | 2013-08-05 |
| 1316216716 | Middleton & Belknap Pediatric Dentistry Pllc | Dentist | 6643 U S Highway 98, Hattiesburg, MS 39402-8442 | 2011-12-14 |
| 1013210624 | Pediatric Dental Group of Hattiesburg, Pllc | Dentist | 6643 Us Highway 98, Hattiesburg, MS 39402-8442 | 2010-12-21 |
| 1720213788 | Fesmire Dental Pllc | Dentist | 101 Avalon Ct, Suite C, Brandon, MS 39047-7641 | 2009-05-20 |
| 1740435668 | Drew Middleton, Dmd | Dentist | 163 Turtle Creek Dr, Suite 80, Hattiesburg, MS 39402-1284 | 2008-11-19 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.