Organization
BENHAM ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY LUSTIG (OWNER)
(817) 350-6500
Entity
Organization
Contact information
Practice address
4060 LEGACY DR STE 303, FRISCO, TX 75034-6658
(214) 618-8182
(214) 618-8184
Mailing address
4060 LEGACY DR STE 303, FRISCO, TX 75034-6658
(214) 618-8182
(214) 618-8184
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
197672201
—
TX
Enumeration date
02/13/2008
Last updated
03/07/2024
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