Organization
SOUTHERN PINES DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSE ROBERTS JR. DDS (OWNER/DENTIST)
(318) 855-1426
Entity
Organization
Contact information
Practice address
1416 HAZEL ST, ARCADIA, LA 71001-4114
(318) 855-1426
(318) 579-5038
Mailing address
1416 HAZEL ST., ARCADIA, LA 71001
(318) 855-1426
(318) 579-5038
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3586
LA
1223G0001X
General Practice Dentistry
6627
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1835862
—
LA
05
—
32635
—
LA
Enumeration date
06/08/2016
Last updated
06/08/2016
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