# PEACH TREE DENTAL JONESBORO, L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396198248
- **Authorized official:** DR. JESSE HENTON ROBERTS III D.D.S. (OWNER/DENTIST)
- **Authorized official phone:** (318) 259-4161

## Contact information

- **Practice address:** 602 PERSHING HWY, JONESBORO, LA 71251-2040
- **Practice address phone:** (318) 259-4161
- **Practice address fax:** (318) 259-1473
- **Mailing address:** 602 PERSHING HWY, JONESBORO, LA 71251-2040
- **Mailing address phone:** (318) 259-4161
- **Mailing address fax:** (318) 259-1473

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 3857 | LA | Yes |

## Other

- **Enumeration date:** 07/15/2016
- **Last updated:** 07/15/2016