Organization
LUSTIG AND YOUNG ORTHODONTICS
Active
Parent organization
FPDS LYO PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
FPDS LYO PLLC
Authorized official
JEREMY LUSTIG DDS, MS, PA (OWNER)
(817) 350-6500
Entity
Organization
Contact information
Practice address
8450 PARK VISTA BLVD, FORT WORTH, TX 76137-5731
(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
06/11/2015
Last updated
03/01/2024
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