Organization
CL DDS 3 PA
Active
Other names
Grow Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CRAIG LUSTMAN (OWNER)
(410) 804-8380
Entity
Organization
Contact information
Practice address
2500 E HALLANDALE BEACH BLVD STE M, HALLANDALE BEACH, FL 33009-4833
(954) 951-3001
Mailing address
3320 SW 58TH ST, FORT LAUDERDALE, FL 33312-6365
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
06/30/2022
Last updated
06/30/2022
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