Organization
FPDS LYO PLLC
Active
Organization
FPDS LYO PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY LUSTIG DDS (CEO)
(214) 335-0862
Entity
Organization
Contact information
Practice address
8450 PARK VISTA BLVD, FORT WORTH, TX 76137-5731
(817) 514-1717
Mailing address
3575 LONE STAR CIR STE 310, FORT WORTH, TX 76177-8908
(817) 350-6500
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
07/17/2020
Last updated
07/17/2020
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