Provider Demographics
NPI:1922366228
Name:BROOME, ROBERT KEITH JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KEITH
Last Name:BROOME
Suffix:JR
Gender:M
Credentials:DDS
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Mailing Address - Street 1:10700 MEDLOCK BRIDGE ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097
Mailing Address - Country:US
Mailing Address - Phone:770-813-0079
Mailing Address - Fax:770-814-7407
Practice Address - Street 1:3875 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-5287
Practice Address - Country:US
Practice Address - Phone:770-447-9808
Practice Address - Fax:770-447-6002
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2015-10-08
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Provider Licenses
StateLicense IDTaxonomies
GA97111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice