Organization
SUSAN ROBERTS PEDIATRIC DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY LUSTIG DDS (CEO)
(214) 335-0862
Entity
Organization
Contact information
Practice address
5411 BASSWOOD BLVD STE 201, FORT WORTH, TX 76137-4479
(817) 656-3999
Mailing address
3575 LONE STAR CIR STE 310, FORT WORTH, TX 76177-8908
(817) 350-6500
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
07/17/2020
Last updated
07/17/2020
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