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REGGIE H. BROOM, D.M.D., P.A.
NPI 1215280672
Dentist - Pediatric Dentistry in Gulfport, MS

Active since October 23, 2012
1635 E PASS RD, GULFPORT, MS 39507(228) 896-5197(228) 896-5192 Get Directions Write a Review

NPPES record last updated: October 23, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Reggie H. Broom, D.m.d., P.a. NPPES

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

REGGIE H. BROOM, D.M.D., P.A. (NPI 1215280672) is a healthcare organization registered as a pediatric dentistry in Gulfport, Mississippi and active in the NPI registry since October 2012. The organization lists Reggie Harris Broom, Pediatric Dentist/owner, as its authorized official.

NPPES Registry Identity

NPI1215280672
Entity TypeOrganization
Primary Taxonomy1223P0221X
Legal Business NameREGGIE H. BROOM, D.M.D., P.A.
Location Address1635 E PASS RDGulfport, MS 39507-3527
Mailing Address1635 E Pass RdGulfport, MS 39507-3527 · (228) 896-5197 · Fax (228) 896-5192
Phone(228) 896-5197
Fax(228) 896-5192
Organization SubpartNo
Authorized OfficialReggie Harris BroomPediatric Dentist/owner · (228) 896-5197
Enumeration DateOctober 23, 2012
✔ NPI 1215280672 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
License✔ Licensed in MS · 2005-83
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 RD, Gulfport, MS 39507
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Other Identifiers 3

Medicaid09015230MS
Medicaid07734393MS
Other466176MS · United Concordia

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

COASTKIDS PEDIATRIC DENTISTRY, PLLC
Dentist (Pediatric Dentistry)
1635 E PASS RD
GULFPORT, MS 39507
Harrison County (228) 896-5197
DR. KRISTEN MULLINS DOUGLAS DMD
Dentist (Pediatric Dentistry)
1635 E PASS RD
GULFPORT, MS 39507
Harrison County (228) 896-5197

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 H. Broom, D.M.D., P.A.'s NPI number?

The NPI number for Reggie H. Broom, D.M.D., P.A. is 1215280672. It was assigned to this organization in the NPPES registry on October 23, 2012.

Where is Reggie H. Broom, D.M.D., P.A. located?

Reggie H. Broom, D.M.D., P.A. is located at 1635 E Pass Rd, Gulfport, MS 39507. The listed phone number is (228) 896-5197.

What is Reggie H. Broom, D.M.D., P.A.'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 H. Broom, D.M.D., P.A. was last updated on October 23, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.