Individual
DR. JEREMY RUSSELL LUSTIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S., P.A.
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
20612
TX
Other
Enumeration date
10/17/2006
Last updated
02/28/2024
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