NPIMap

Organization Active NPI

Peach Tree Dental Management LLC

  • General Practice Dentistry
  • Ruston, LA
National Provider Identifier
1154591501
Registry record updated Mar 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5205 Issued in LA
Legal business name
PEACH TREE DENTAL MANAGEMENT LLC
Practice address
702 N Trenton St
Ruston, LA 71270-3324
Phone
(318) 255-9440
Fax
(318) 251-1270
NPI assigned
Mar 1, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2008

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

Authorized official

Name
Dr. Jesse Henton Roberts III, D.D.S.NPI 1326197930
Title
Owner/Dentist
Phone
(318) 255-9440

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 5205 LA Primary

Addresses

Primary practice location

702 N Trenton St
Ruston, LA 71270-3324

Mailing address

136 Red Oak
Ruston, LA 71270-8762
Phone (318) 513-2654

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1204329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204329600000",
    "number": "1154591501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 RED OAK",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712708762",
            "telephone_number": "318-513-2654",
            "fax_number": "318-251-1270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACH TREE DENTAL MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-01",
        "last_updated": "2008-03-01",
        "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": "318-255-9440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "5205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ruston, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2008; 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.