The Pediatric Dental Studio, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

3662-12 Issued in MS

Legal business name

THE PEDIATRIC DENTAL STUDIO, LLC

Practice address

110 Metroplex Blvd
Pearl, MS 39208-9210

Phone

(601) 941-6237

NPI assigned

Jan 13, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jerrick W Rose, D.M.D.NPI 1801150958

Title

Owner

Phone

(601) 941-6237

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jerrick W Rose, D.M.D.

  • Pediatric Dentistry
  • Jackson, MS
  • NPI 1801150958
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389571200000",
    "number": "1699197574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 SOUTHERN OAKS DR",
            "city": "FLORENCE",
            "state": "MS",
            "postal_code": "390739456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 METROPLEX BLVD",
            "city": "PEARL",
            "state": "MS",
            "postal_code": "392089210",
            "telephone_number": "601-941-6237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PEDIATRIC DENTAL STUDIO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-13",
        "last_updated": "2014-01-13",
        "status": "A",
        "authorized_official_last_name": "ROSE",
        "authorized_official_first_name": "JERRICK",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-941-6237",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MS",
            "license": "3662-12",
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MS",
            "license": "3662-12",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Pate Suggs, LPC
• Super D Drugs Acquisition Co. (Super D Drugs #139)
• Barbara L Tapps, FNP
• Tara Pharmacy SE LLC
• The Medical Foundation of Central Mississippi (Baptist Medical Clinic - Internal Medicine)
• Deidra Thompson, FNP
• Dornette Thompson, LMSW
• Kristel Heckman Thrash, LPC
• Thrive Pediatrics PLLC
• Margaret E. Tidd, M.D.

• Pediatric Dentistry in Pearl, MS
• Providers in Pearl, MS by specialty
• Pediatric Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.