Peach Tree for Kids - Ruston, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

5205 Issued in LA

Legal business name

PEACH TREE FOR KIDS - RUSTON, LLC

Practice address

206 E Vaughn Ave
Ruston, LA 71270-5926

Phone

(318) 255-7760

NPI assigned

Feb 8, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jesse Henton Roberts III, D.D.S.

Title

Owner/Dentist

Phone

(318) 255-7760

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joe William Gilmore, DDS

  • Pediatric Dentistry
  • Ruston, LA
  • NPI 1124133954
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1360281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360281600000",
    "number": "1144569252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 N TRENTON ST",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712703324",
            "telephone_number": "318-255-9440",
            "fax_number": "318-251-1270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 E VAUGHN AVE",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712705926",
            "telephone_number": "318-255-7760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACH TREE FOR KIDS - RUSTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-08",
        "last_updated": "2013-02-08",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "JESSE",
        "authorized_official_middle_name": "HENTON",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "318-255-7760",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "LA",
            "license": "5205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Llwendellyn Paul
• Claudia Payne
• PCG Group, LLC
• Peach Tree Dental Holdings, LLC
• Peach Tree Dental Management LLC
• Shelby Moore Pearce, LPC
• Pelvic Health and Menopause Center LLC
• People Centered Support Services
• People Centered Support Services, Inc.
• People Centered Support Services, Inc.

• Pediatric Dentistry in Ruston, LA
• Providers in Ruston, LA by specialty
• Pediatric Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.