NPIMap

Organization Active NPI

Lustig and Young Orthodontics

Doing business as Lustig & Young Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Keller, TX
National Provider Identifier
1336906882
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
LUSTIG AND YOUNG ORTHODONTICS
Doing business as
Lustig & Young Orthodontics
Practice address
601 S Main St
Keller, TX 76248-7029
Phone
(817) 514-1717
Fax
(817) 704-4771
NPI assigned
Mar 1, 2024
Last updated
Mar 1, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
FPDS LYO PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 1, 2024

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

Authorized official

Name
Jeremy LustigNPI 1760562235
Title
Owner
Phone
(817) 350-6500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X NU Primary

Addresses

Primary practice location

601 S Main St
Keller, TX 76248-7029

Mailing address

8450 Park Vista Blvd
Fort Worth, TX 76137-5731
Phone (817) 514-1717

Other names 1

  • Lustig & Young Orthodontics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lustig and Young Orthodontics5 organizations share this tax ID, including this one
Part of
FPDS Lyo PLLC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1709251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709251200000",
    "number": "1336906882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8450 PARK VISTA BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761375731",
            "telephone_number": "817-514-1717",
            "fax_number": "817-704-4771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 S MAIN ST",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762487029",
            "telephone_number": "817-514-1717",
            "fax_number": "817-704-4771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUSTIG AND YOUNG ORTHODONTICS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FPDS LYO PLLC",
        "enumeration_date": "2024-03-01",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A",
        "authorized_official_last_name": "LUSTIG",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-350-6500"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lustig & Young Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Keller, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; 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.