| NPI | 1154591501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE HENTON ROBERTS Owner/Dentist 318-255-9440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 5205) |
| Enumeration Date | 2008-03-01 |
| Last Update Date | 2008-03-01 |