Organization
LUSTIG AND YOUNG ORTHODONTICS
Active
Organization
LUSTIG AND YOUNG ORTHODONTICS
Active
Parent organization
FPDS LYO PLLC
Other names
Lustig & Young Orthodontics
Organization subpart
Yes
Provider details
NPI number
Legal business name
FPDS LYO PLLC
Authorized official
JEREMY LUSTIG (OWNER)
(817) 350-6500
Entity
Organization
Contact information
Practice address
705 W BAILEY BOSWELL RD STE 100, SAGINAW, TX 76179-1020
(817) 514-1717
(817) 704-4771
Mailing address
8450 PARK VISTA BLVD, FORT WORTH, TX 76137-5731
(817) 514-1717
(817) 704-4771
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
03/01/2024
Last updated
03/01/2024
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