Provider Demographics
NPI:1376557561
Name:BROOME, ANGELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:BROOME
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LAKESIDE ANNEX #7
Mailing Address - Street 2:MAIL STOP 701
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-4354
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ECU SCHOOL OF DENTAL MEDICINE, LAKESIDE ANNEX #7
Practice Address - Street 2:MAIL STOP 701
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4354
Practice Address - Country:US
Practice Address - Phone:252-737-7040
Practice Address - Fax:252-737-7049
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC60131223G0001X, 1223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
No1223G0001XDental ProvidersDentistGeneral Practice