| NPI | 1215280672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGGIE HARRIS BROOM Pediatric Dentist/Owner 228-896-5197 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MS 2005-83) |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2012-10-23 |