NPIMap

Organization Active NPI

Southern Pines Dental, LLC

  • General Practice Dentistry
  • Arcadia, LA
National Provider Identifier
1922457175
Registry record updated Jun 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3586 Issued in LA
Legal business name
SOUTHERN PINES DENTAL, LLC
Practice address
1416 Hazel St
Arcadia, LA 71001-4114
Phone
(318) 855-1426
Fax
(318) 579-5038
NPI assigned
Jun 8, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2016

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

Authorized official

Name
Dr. Jesse Roberts Jr., DDS
Title
Owner/Dentist
Phone
(318) 855-1426

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 3586 LA Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 6627 LA

Addresses

Primary practice location

1416 Hazel St
Arcadia, LA 71001-4114

Mailing address

1416 Hazel St.
Arcadia, LA 71001
Phone (318) 855-1426

Other identifiers 2

IdentifierTypeStateIssuer
1835862MedicaidLA
32635MedicaidLA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1465344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465344000000",
    "number": "1922457175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1416 HAZEL ST.",
            "city": "ARCADIA",
            "state": "LA",
            "postal_code": "71001",
            "telephone_number": "318-855-1426",
            "fax_number": "318-579-5038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1416 HAZEL ST",
            "city": "ARCADIA",
            "state": "LA",
            "postal_code": "710014114",
            "telephone_number": "318-855-1426",
            "fax_number": "318-579-5038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PINES DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-08",
        "last_updated": "2016-06-08",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "JESSE",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "318-855-1426",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "3586",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "6627",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1835862",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32635",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Arcadia, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 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.