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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 2025-02-01 Annual Report For Madison Pediatric Dental Group, PLLC
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

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
7002678510 2021-03-05 0470 PPS 7728 Old Canton Rd, Madison, MS, 39110-6103
Loan Status Date 2021-10-15
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 110730
Loan Approval Amount (current) 110730
Undisbursed Amount 0
Franchise Name -
Lender Location ID 529471
Servicing Lender Name Itria Ventures LLC
Servicing Lender Address One Penn Plaza, Suite 4530, New York, NY, 10119
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Madison, MADISON, MS, 39110-6103
Project Congressional District MS-03
Number of Employees 16
NAICS code 621210
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Partnership
Originating Lender ID 529471
Originating Lender Name Itria Ventures LLC
Originating Lender Address New York, NY
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 111160.62
Forgiveness Paid Date 2021-09-08
1104357200 2020-04-15 0470 PPP 7728 OLD CANTON RD, MADISON, MS, 39110-6103
Loan Status Date 2021-05-18
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 111400
Loan Approval Amount (current) 111400
Undisbursed Amount 0
Franchise Name -
Lender Location ID 40010
Servicing Lender Name Renasant Bank
Servicing Lender Address 209 Troy St, TUPELO, MS, 38804-4827
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address MADISON, MADISON, MS, 39110-6103
Project Congressional District MS-03
Number of Employees 12
NAICS code 621210
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Partnership
Originating Lender ID 40010
Originating Lender Name Renasant Bank
Originating Lender Address TUPELO, MS
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 112461.39
Forgiveness Paid Date 2021-04-15

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Date of last update: 26 Mar 2025

Sources: Mississippi Secretary of State

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