Eagle Mountain Pediatric Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

EAGLE MOUNTAIN PEDIATRIC DENTISTRY

Practice address

705 W Bailey Boswell Rd
Saginaw, TX 76179-1020

Phone

(817) 576-1600

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

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": "1669080487",
    "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": "705 W BAILEY BOSWELL RD",
            "city": "SAGINAW",
            "state": "TX",
            "postal_code": "761791020",
            "telephone_number": "817-576-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE MOUNTAIN PEDIATRIC DENTISTRY",
        "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": []
}

• Kwabuaa Dow, MD
• Gail Patricia Dowda, COTA
• Dr. Fred a. Loe D.D.S., P.a. (North Tarrant OMFS)
• Dream Diagnostic Sleep Services, LLC
• Mary Kristin Dryg, OWNER-KD DIAGNOSTICS
• Eagle Mountain Saginaw Isd
• Edge-MD Saginaw, PLLC
• Ensure Dental Care PLLC
• April Farris, AGPCNP
• Omar Fetouh, D.D.S

• Pediatric Dentistry in Saginaw, TX
• Providers in Saginaw, 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.