Organization
PEACH TREE DENTAL MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSE HENTON ROBERTS III D.D.S. (OWNER/DENTIST)
(318) 255-9440
Entity
Organization
Contact information
Practice address
702 N TRENTON ST, RUSTON, LA 71270-3324
(318) 255-9440
(318) 251-1270
Mailing address
136 RED OAK, RUSTON, LA 71270-8762
(318) 513-2654
(318) 251-1270
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5205
LA
Other
Enumeration date
03/01/2008
Last updated
03/01/2008
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