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
5341 W UNIVERSITY DR STE 200, MCKINNEY, TX 75071-7824
(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
Enumeration date
03/01/2024
Last updated
03/01/2024
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