| NPI | 1881451342 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY LUSTIG Owner 817-350-6500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2024-03-01 |
| Last Update Date | 2024-03-01 |