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  5. Madison Pediatric Dental Group, PLLC

Madison Pediatric Dental Group, PLLC

Company Details

Name: Madison Pediatric Dental Group, PLLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 14 Nov 2003 (21 years ago)
Business ID: 741913
ZIP code: 39110
County: Madison
State of Incorporation: MISSISSIPPI
Principal Office Address: 7728 Old Canton RoadMADISON, MS 39110
Historical names: GAYLE M. WATTERS D.M.D., P.L.L.C.

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MADISON PEDIATRIC DENTAL GROUP, PLLC 401(K) PROFIT SHARING PLAN 2023 830374846 2024-07-17 MADISON PEDIATRIC DENTAL GROUP, PLLC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 6018561011
Plan sponsor’s address 7728 OLD CANTON RD., SUITE A, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2024-07-17
Name of individual signing AMY JONES
Valid signature Filed with authorized/valid electronic signature
MADISON PEDIATRIC DENTAL GROUP, PLLC 401(K) PROFIT SHARING PLAN 2022 830374846 2023-08-17 MADISON PEDIATRIC DENTAL GROUP, PLLC 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 6018561011
Plan sponsor’s address 7728 OLD CANTON RD., SUITE A, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2023-08-17
Name of individual signing AMY JONES
Valid signature Filed with authorized/valid electronic signature
MADISON PEDIATRIC DENTAL GROUP, PLLC 401(K) PROFIT SHARING PLAN 2021 830374846 2022-09-22 MADISON PEDIATRIC DENTAL GROUP, PLLC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 6018561511
Plan sponsor’s address 7728 OLD CANTON RD. SUITE A, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2022-09-22
Name of individual signing AMY JONES
Valid signature Filed with authorized/valid electronic signature
MADISON PEDIATRIC DENTAL GROUP, PLLC 401(K) PROFIT SHARING PLAN 2020 830374846 2021-06-07 MADISON PEDIATRIC DENTAL GROUP, PLLC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 6018561511
Plan sponsor’s address 7728 OLD CANTON RD. SUITE A, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2021-06-07
Name of individual signing AMY JONES
Valid signature Filed with authorized/valid electronic signature
MADISON PEDIATRIC DENTAL GROUP, PLLC 401(K) PROFIT SHARING PLAN 2019 830374846 2020-06-15 MADISON PEDIATRIC DENTAL GROUP, PLLC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 6018561511
Plan sponsor’s address 7728 OLD CANTON RD. SUITE A, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2020-06-15
Name of individual signing AMY JONES
Valid signature Filed with authorized/valid electronic signature
MADISON PEDIATRIC DENTAL GROUP, PLLC 401(K) PROFIT SHARING PLAN 2018 830374846 2019-07-17 MADISON PEDIATRIC DENTAL GROUP, PLLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 6018561511
Plan sponsor’s address 7728 OLD CANTON RD. , SUITE A, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2019-07-17
Name of individual signing AMY JONES
Valid signature Filed with authorized/valid electronic signature
MADISON PEDIATRIC DENTAL GROUP, PLLC 401(K) PROFIT SHARING PLAN 2017 830374846 2018-04-26 MADISON PEDIATRIC DENTAL GROUP, PLLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 6018561511
Plan sponsor’s address 7728 OLD CANTON RD. , SUITE A, SUITE A, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2018-04-26
Name of individual signing AMY JONES
Valid signature Filed with authorized/valid electronic signature
MADISON PEDIATRIC DENTAL GROUP, PLLC 401(K) PROFIT SHARING PLAN 2016 830374846 2017-06-02 MADISON PEDIATRIC DENTAL GROUP, PLLC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 6018561511
Plan sponsor’s address 7728 OLD CANTON RD., SUITE A, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2017-06-02
Name of individual signing AMY JONES
Valid signature Filed with authorized/valid electronic signature
MADISON PEDIATRIC DENTAL GROUP, PLLC 401(K) PROFIT SHARING PLAN 2015 830374846 2016-07-25 MADISON PEDIATRIC DENTAL GROUP, PLLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 6018561511
Plan sponsor’s address 7728 OLD CANTON RD. , SUITE A, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2016-07-25
Name of individual signing AMY JONES
Valid signature Filed with authorized/valid electronic signature
MADISON PEDIATRIC DENTAL GROUP PLLC 401(K) PROFIT SHARING PLAN 2014 830374846 2015-10-13 MADISON PEDIATRIC DENTAL GROUP PLLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 6018561511
Plan sponsor’s address 7728 OLD CANTON ROAD, SUITE A, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2015-10-13
Name of individual signing AMY G JONES, DMD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-10-13
Name of individual signing AMY G JONES, DMD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/07/31/20140731103448P040064793223001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 6018561511
Plan sponsor’s address 7728 OLD CANTON ROAD, SUITE A, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2014-07-31
Name of individual signing AMY G JONES, DMD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-31
Name of individual signing AMY G JONES, DMD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/06/11/20130611130856P040255486771001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 6018561511
Plan sponsor’s address 7728 OLD CANTON ROAD, SUITE A, MADISON, MS, 39110

Signature of
Role Plan administrator
Date 2013-06-11
Name of individual signing AMY G JONES, DMD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-06-11
Name of individual signing AMY G JONES, DMD
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 6018561511
Plan sponsor’s address 7728 OLD CANTON ROAD, SUITE A, MADISON, MS, 39110

Plan administrator’s name and address
Administrator’s EIN 830374846
Plan administrator’s name MADISON PEDIATRIC DENTAL GROUP PLLC
Plan administrator’s address 7728 OLD CANTON ROAD, SUITE A, MADISON, MS, 39110
Administrator’s telephone number 6018561511

Signature of
Role Plan administrator
Date 2012-04-12
Name of individual signing AMY G. JONES, DMD
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2012-04-12
Name of individual signing AMY G. JONES, DMD
Valid signature Filed with incorrect/unrecognized electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/04/12/20120412130015P030304715264001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 6018561511
Plan sponsor’s address 7728 OLD CANTON ROAD, SUITE A, MADISON, MS, 39110

Plan administrator’s name and address
Administrator’s EIN 830374846
Plan administrator’s name MADISON PEDIATRIC DENTAL GROUP PLLC
Plan administrator’s address 7728 OLD CANTON ROAD, SUITE A, MADISON, MS, 39110
Administrator’s telephone number 6018561511

Signature of
Role Plan administrator
Date 2012-04-12
Name of individual signing AMY G JONES, DMD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-04-12
Name of individual signing AMY G JONES, DMD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/04/29/20110429161124P030015682631001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 6018561511
Plan sponsor’s address 7728 OLD CANTON ROAD, SUITE A, MADISON, MS, 39110

Plan administrator’s name and address
Administrator’s EIN 830374846
Plan administrator’s name MADISON PEDIATRIC DENTAL GROUP PLLC
Plan administrator’s address 7728 OLD CANTON ROAD, SUITE A, MADISON, MS, 39110
Administrator’s telephone number 6018561511

Signature of
Role Plan administrator
Date 2011-04-29
Name of individual signing AMY G. JONES, DMD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-04-29
Name of individual signing AMY G. JONES, DMD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/08/25/20100825131523P070007395400001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 6018561511
Plan sponsor’s address 7728 OLD CANTON ROAD, SUITE A, MADISON, MS, 39110

Plan administrator’s name and address
Administrator’s EIN 830374846
Plan administrator’s name MADISON PEDIATRIC DENTAL GROUP PLLC
Plan administrator’s address 7728 OLD CANTON ROAD, SUITE A, MADISON, MS, 39110
Administrator’s telephone number 6018561511

Signature of
Role Plan administrator
Date 2010-08-25
Name of individual signing GAYLE M. WATTERS, DMD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-08-25
Name of individual signing GAYLE M. WATTERS, DMD
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Gayle Watters Agent 7728 Old Canton Road, Madison, MS 39110

Member

Name Role Address
Gayle Watters Member 7728 Old Canton Rd, Madison, MS 39110
Amy Jones Member 7728 Old Canton Road, Madison, MS 39110

Filings

Type Status Filed Date Description
Annual Report LLC Filed 2024-01-27 Annual Report For Madison Pediatric Dental Group, PLLC
Annual Report LLC Filed 2023-01-28 Annual Report For Madison Pediatric Dental Group, PLLC
Annual Report LLC Filed 2022-01-29 Annual Report For Madison Pediatric Dental Group, PLLC
Annual Report LLC Filed 2021-11-15 Annual Report For Madison Pediatric Dental Group, PLLC
Annual Report LLC Filed 2021-01-23 Annual Report For Madison Pediatric Dental Group, PLLC
Annual Report LLC Filed 2020-02-01 Annual Report For Madison Pediatric Dental Group, PLLC
Annual Report LLC Filed 2019-02-02 Annual Report For Madison Pediatric Dental Group, PLLC
Annual Report LLC Filed 2018-02-03 Annual Report For Madison Pediatric Dental Group, PLLC
Annual Report LLC Filed 2017-01-26 Annual Report For Madison Pediatric Dental Group, PLLC
Annual Report LLC Filed 2016-01-23 Annual Report For Madison Pediatric Dental Group, PLLC

Related by officers

Amy Jones

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Related by address

No related companies by address

Date of last update: 07 Jan 2025

Sources: Mississippi Secretary of State

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