| The Pediatric Dental Studio, Llc | |
|
110 Metroplex Blvd Pearl MS 39208-9210 | |
| (601) 941-6237 | |
| Not Available |
| Full Name | The Pediatric Dental Studio, Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 110 Metroplex Blvd, Pearl, Mississippi |
| Authorized Official Name and Position | Jerrick W Rose (OWNER) |
| Authorized Official Contact | 6019416237 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Pediatric Dental Studio, Llc 603 Southern Oaks Dr Florence MS 39073-9456 Ph: () - | The Pediatric Dental Studio, Llc 110 Metroplex Blvd Pearl MS 39208-9210 Ph: (601) 941-6237 |
| NPI Number | 1699197574 |
|---|---|
| Provider Enumeration Date | 01/13/2014 |
| Last Update Date | 01/13/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699197574 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 3662-12 (Mississippi) | Primary |
| 261QD0000X | Clinic/center - Dental | 3662-12 (Mississippi) | Secondary |
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