| NPI | 1699197574 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRICK W ROSE Owner 601-941-6237 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MS 3662-12) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: MS 3662-12) |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2014-01-13 |