Susan Roberts Pediatric Dentistry PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

SUSAN ROBERTS PEDIATRIC DENTISTRY PLLC

Practice address

5411 Basswood Blvd Ste 201
Fort Worth, TX 76137-4479

Phone

(817) 656-3999

NPI assigned

Jul 17, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeremy Lustig, DDS

Title

Ceo

Phone

(214) 335-0862

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Susan Merlene Roberts, DDS

  • Pediatric Dentistry
  • Ft Worth, TX
  • NPI 1114023736
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594944000000",
    "number": "1306454178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3575 LONE STAR CIR STE 310",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761778908",
            "telephone_number": "817-350-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5411 BASSWOOD BLVD STE 201",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761374479",
            "telephone_number": "817-656-3999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12485 Timberland Blvd Ste 703",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "762446429",
            "country_code": "US",
            "telephone_number": "817-337-9720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SUSAN ROBERTS PEDIATRIC DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-17",
        "last_updated": "2020-07-17",
        "certification_date": "2020-07-17",
        "status": "A",
        "authorized_official_last_name": "LUSTIG",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "214-335-0862",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sajid Ali Surve, DO
• Survivor Gals Specialty Products and Salon LLC
• Susan Arnold Lange, Psychologist, LPPC
• Susan K Linder MD PA
• Susan R. Bailey, M.D.P.a.
• Susan Roberts, DDS, Ms
• Andrea Jennys Sustache Medina
• Bhoomi Sutaria, D.O.
• Paula Suter, RN
• Hannah Leigh Sutherland

• Pediatric Dentistry in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.