Provider Demographics
NPI:1922199512
Name:BROOME, CRAIG C (DMD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:C
Last Name:BROOME
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 49TH STREET N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-3508
Mailing Address - Country:US
Mailing Address - Phone:727-328-7929
Mailing Address - Fax:727-328-0737
Practice Address - Street 1:2201 49TH STREET N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-3508
Practice Address - Country:US
Practice Address - Phone:727-328-7929
Practice Address - Fax:727-328-0737
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN130401223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics