# THE PEDIATRIC DENTAL STUDIO, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699197574
- **Authorized official:** DR. JERRICK W ROSE D.M.D. (OWNER)
- **Authorized official phone:** (601) 941-6237

## Contact information

- **Practice address:** 110 METROPLEX BLVD, PEARL, MS 39208-9210
- **Practice address phone:** (601) 941-6237
- **Mailing address:** 603 SOUTHERN OAKS DR, FLORENCE, MS 39073-9456

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 3662-12 | MS | Yes |
| 261QD0000X | Dental Clinic/Center | 3662-12 | MS | — |

## Other

- **Enumeration date:** 01/13/2014
- **Last updated:** 01/13/2014