Jesse Henton Roberts III, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5205 Issued in LA

Practice address

702 N Trenton St
Ruston, LA 71270-3324

Phone

(318) 255-9440

Fax

(318) 251-1270

NPI assigned

Jan 10, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Peach Tree Dental Management LLC

  • General Practice Dentistry
  • Ruston, LA
  • NPI 1154591501
  NPD (past) Authorized official

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1326197930",
    "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": "318-255-9440",
            "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": {
        "last_name": "ROBERTS",
        "first_name": "JESSE",
        "middle_name": "HENTON",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "5205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly A Roach, D.P.T.
• David Jacob Roark
• Robert B Kirton, DPM Inc
• Robert C. Rendina, D.C., Apc
• Jesse Henton Roberts Jr., DDS
• Annie Robertson, M.A., CCC-SLP
• Gerald Melvin Robertson, M.D.
• Rochelle Robicheaux Metoyer, M.D.
• Bria Robinson, BCBA
• Tiffani Amber Robinson, LPC-A

• General Practice Dentistry in Ruston, LA
• Providers in Ruston, LA by specialty
• General Practice Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.