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REGGIE HARRIS BROOM DMD
NPI 1063588788
Dentist - Pediatric Dentistry in Gulfport, MS

Active since November 27, 2006
1635 E PASS ROAD, GULFPORT, MS 39507(228) 896-5197(228) 896-5192 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Reggie Harris Broom Dmd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

REGGIE HARRIS BROOM DMD (NPI 1063588788) is an individual pediatric dentistry provider in Gulfport, Mississippi, licensed in Mississippi (200583) and active in the NPI registry since November 2006.

NPPES Registry Identity

NPI1063588788
Entity TypeIndividualMale
Primary Taxonomy1223P0221X
Provider Legal NameREGGIE HARRIS BROOMCredential: DMD
Location Address1635 E PASS ROADGulfport, MS 39507
Mailing Address1635 E Pass RoadGulfport, MS 39507 · (228) 896-5197 · Fax (228) 896-5192
Phone(228) 896-5197
Fax(228) 896-5192
Sole ProprietorNo
Enumeration DateNovember 27, 2006
Last NPPES UpdateJuly 8, 2007
✔ NPI 1063588788 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
Licenses✔ Licensed in MS · 200583✔ Licensed in MS · 11986
Definition

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.

1635 E PASS ROAD, Gulfport, MS 39507
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Other Identifiers 1

OtherH66176MS · United Concordia

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Reggie Broom's NPI number?

The NPI number for Reggie Broom is 1063588788. It was assigned to this individual provider in the NPPES registry on November 27, 2006.

Where is Reggie Broom located?

Reggie Broom practices at 1635 E Pass Road, Gulfport, MS 39507. The listed phone number is (228) 896-5197.

What is Reggie Broom's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

When was this NPI record last updated?

The NPPES record for Reggie Broom was last updated on July 8, 2007. NPI Profile syncs with the weekly NPPES data releases published by CMS.