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Organization
THE PEDIATRIC DENTAL STUDIO, LLC
Active
Organization
THE PEDIATRIC DENTAL STUDIO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRICK W ROSE D.M.D. (OWNER)
(601) 941-6237
Entity
Organization
Contact information
Practice address
110 METROPLEX BLVD, PEARL, MS 39208-9210
(601) 941-6237
Mailing address
603 SOUTHERN OAKS DR, FLORENCE, MS 39073-9456
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
3662-12
MS
261QD0000X
Dental Clinic/Center
3662-12
MS
Other
Enumeration date
01/13/2014
Last updated
01/13/2014
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