Peach Tree Dental Holdings, LLC
Dentist, General Practice in Ruston, LA. Organization (NPI-2).
NPI number1528404795
StatusActive
Last updated in NPPESMay 15, 2013
Details
- NPI
- 1528404795
- Entity type
- Organization (NPI-2)
- Legal business name
- Peach Tree Dental Holdings, LLC
- Organization subpart
- No
- Enumeration date
- May 15, 2013
- Last updated
- May 15, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 5205 | LA | Yes |
Other names
- Peach Tree Dental (Doing Business As)
Practice location
702 N Trenton StRuston, LA 71270-3324
Phone 318-255-9440 · Fax 318-251-1270
Mailing address
702 N Trenton StRuston, LA 71270-3324
Phone 318-255-9440 · Fax 318-251-1270
Authorized official
Jesse Henton Roberts
Owner/Dentist
3182559440
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