Individual
JERRICK W ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216
(601) 984-6100
(601) 815-5837
Mailing address
603 SOUTHERN OAKS DR, FLORENCE, MS 39073-9456
(601) 941-6237
(601) 815-5837
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
3662-12
MS
1223P0221X
Pediatric Dentistry
3662-12
MS
1223P0221X
Pediatric Dentistry
Primary
PEDO-482-14
MS
Other
Enumeration date
07/03/2012
Last updated
06/13/2018
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