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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
570 FM 156 S STE 200, HASLET, TX 76052-3626
(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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