Peach Tree Dental Jonesboro, L.L.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3857 Issued in LA

Legal business name

PEACH TREE DENTAL JONESBORO, L.L.C.

Practice address

602 Pershing Hwy
Jonesboro, LA 71251-2040

Phone

(318) 259-4161

Fax

(318) 259-1473

NPI assigned

Jul 15, 2016

Last updated

Jul 15, 2016By the provider in NPPES

Organization subpart

No

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.

Title

Owner/Dentist

Phone

(318) 259-4161

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Christopher Jacob Antee, DDS

  • Dentist
  • Jonesboro, LA
  • NPI 1841991593
  NPD (past)
• Shawn Perry, DDS

  • General Practice Dentistry
  • Jonesboro, LA
  • NPI 1043818073
  NPD (past)

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

{
    "created_epoch": "1468540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468540800000",
    "number": "1396198248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 PERSHING HWY",
            "city": "JONESBORO",
            "state": "LA",
            "postal_code": "712512040",
            "telephone_number": "318-259-4161",
            "fax_number": "318-259-1473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 PERSHING HWY",
            "city": "JONESBORO",
            "state": "LA",
            "postal_code": "712512040",
            "telephone_number": "318-259-4161",
            "fax_number": "318-259-1473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACH TREE DENTAL JONESBORO, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-15",
        "last_updated": "2016-07-15",
        "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": "318-259-4161",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "3857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ali Trinh Nguyen, PHARMD
• Dionne R Nolan, D.P.M.
• Diogenee Osborne
• Brandi Outley
• John Leon Overby, MD
• Peniel Collective LLC (Enoch Transport)
• Shawn Perry, DDS
• Kail Pikes
• Piney Woods First Class Transportation LLC
• Premier Care Transit

• General Practice Dentistry in Jonesboro, LA
• Providers in Jonesboro, 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 15, 2016; 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.