| NPI | 1881839231 |
|---|---|
| Doing Business As | PEACH TREE DENTAL MONROE |
| Entity Type | Organization |
| Authorized Contact | JESSE HENTON ROBERTS President 318-325-4220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 5843) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 5205) |
| 1223G0001X Dentist, General Practice (Licence: LA 5807) | |
| 1223G0001X Dentist, General Practice (Licence: LA 3586) | |
| Enumeration Date | 2008-12-12 |
| Last Update Date | 2009-01-15 |