Peach Tree Dental Holdings, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5205 Issued in LA

Legal business name

PEACH TREE DENTAL HOLDINGS, LLC

Doing business as

Peach Tree Dental

Practice address

702 N Trenton St
Ruston, LA 71270-3324

Phone

(318) 255-9440

Fax

(318) 251-1270

NPI assigned

May 15, 2013

Last updated

May 15, 2013By 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) 255-9440

Specialties & licenses 1

Addresses

Other names 1

• Peach Tree Dental Doing business as

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Affordable Dentistry of Louisiana LLC

  • Dentist
  • Monroe, LA
  • NPI 1508267956
  NPPES parent name

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

{
    "created_epoch": "1368576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368576000000",
    "number": "1528404795",
    "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": "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 HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-15",
        "last_updated": "2013-05-15",
        "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": "318-255-9440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "5205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peach Tree Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Abby Patterson
• Jonathon Patterson, PHARMD
• Llwendellyn Paul
• Claudia Payne
• PCG Group, LLC
• Peach Tree Dental Management LLC
• Peach Tree for Kids - Ruston, LLC
• Shelby Moore Pearce, LPC
• Pelvic Health and Menopause Center LLC
• People Centered Support Services

• 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 May 15, 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.