| Peach Tree For Kids - Ruston, Llc | |
|
206 E Vaughn Ave Ruston LA 71270-5926 | |
| (318) 255-7760 | |
| Not Available |
| Full Name | Peach Tree For Kids - Ruston, Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 206 E Vaughn Ave, Ruston, Louisiana |
| Authorized Official Name and Position | Jesse Henton Roberts (OWNER/DENTIST) |
| Authorized Official Contact | 3182557760 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Peach Tree For Kids - Ruston, Llc 702 N Trenton St Ruston LA 71270-3324 Ph: (318) 255-9440 | Peach Tree For Kids - Ruston, Llc 206 E Vaughn Ave Ruston LA 71270-5926 Ph: (318) 255-7760 |
| NPI Number | 1144569252 |
|---|---|
| Provider Enumeration Date | 02/08/2013 |
| Last Update Date | 02/08/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144569252 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 5205 (Louisiana) | Primary |
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Peach Tree Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 702 N Trenton St, Ruston, LA 71270 Phone: 318-255-9440 Fax: 318-251-1270 | |
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