Provider Demographics
NPI:1285843789
Name:BROOME, PATRICK JOSEPH (DMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOSEPH
Last Name:BROOME
Suffix:
Gender:M
Credentials:DMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6849 FAIRVIEW RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3393
Mailing Address - Country:US
Mailing Address - Phone:704-364-4711
Mailing Address - Fax:704-364-1963
Practice Address - Street 1:6849 FAIRVIEW RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3393
Practice Address - Country:US
Practice Address - Phone:704-364-4711
Practice Address - Fax:704-364-1963
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7961122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist