SUSAN ROBERTS PEDIATRIC DENTISTRY PLLC
NPI 1306454178
Dentist - Pediatric Dentistry in Fort Worth, TX

Q: What is Susan Roberts Pediatric Dentistry PLLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Active since July 17, 2020

5411 BASSWOOD BLVD STE 201, FORT WORTH, TX 76137(817) 656-3999 Get Directions Write a Review

NPPES record last updated: July 17, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Susan Roberts Pediatric Dentistry Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SUSAN ROBERTS PEDIATRIC DENTISTRY PLLC (NPI 1306454178) is a healthcare organization registered as a pediatric dentistry in Fort Worth, Texas and active in the NPI registry since July 2020. The organization maintains a secondary practice location in Fort Worth and lists Jeremy Lustig, Ceo, as its authorized official.

NPPES Registry Identity

NPI1306454178

Entity TypeOrganization

Primary Taxonomy1223P0221X

Legal Business NameSUSAN ROBERTS PEDIATRIC DENTISTRY PLLC

Location Address5411 BASSWOOD BLVD STE 201Fort Worth, TX 76137-4479

Mailing Address3575 Lone Star Cir Ste 310Fort Worth, TX 76177-8908 · (817) 350-6500

Phone(817) 656-3999

Organization SubpartNo

Authorized OfficialJeremy LustigCeo · (214) 335-0862

Enumeration DateJuly 17, 2020

NPPES CertifiedJuly 17, 2020

✔ NPI 1306454178 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers

Taxonomy Code1223P0221X

Definition

An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

5411 BASSWOOD BLVD STE 201, Fort Worth, TX 76137

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Secondary Practice Location 1

Location 112485 Timberland Blvd Ste 703Fort Worth, TX 76244-6429 · Phone (817) 337-9720

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Susan Roberts Pediatric Dentistry PLLC's NPI number?

The NPI number for Susan Roberts Pediatric Dentistry PLLC is 1306454178. It was assigned to this organization in the NPPES registry on July 17, 2020.

Where is Susan Roberts Pediatric Dentistry PLLC located?

Susan Roberts Pediatric Dentistry PLLC is located at 5411 Basswood Blvd Ste 201, Fort Worth, TX 76137. The listed phone number is (817) 656-3999.

What is Susan Roberts Pediatric Dentistry PLLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

When was this NPI record last updated?

The NPPES record for Susan Roberts Pediatric Dentistry PLLC was last updated on July 17, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.