Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Susan Roberts Pediatric Dentistry PLLC

Organization Pediatric Dentistry · NPI 1306454178

Susan Roberts Pediatric Dentistry PLLC is a Pediatric Dentistry in Fort Worth, Texas. Works from 2 locations. Registered with an NPI since 2020.

In the registry since
2020
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

5411 Basswood Blvd Ste 201
Fort Worth, TX 76137-4479
Phone: (817) 656-3999
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 12485 Timberland Blvd Ste 703, Fort Worth, TX 76244-6429 — (817) 337-9720

Specialties & licences

Pediatric Dentistry (primary) Taxonomy 1223P0221X

Record details

NPI number1306454178
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jeremy Lustig — Ceo · (214) 335-0862
NPI enumeratedJuly 17, 2020
Last updated in NPPESJuly 17, 2020
Certification dateJuly 17, 2020
Mailing address3575 Lone Star Cir Ste 310, Fort Worth, TX 76177-8908

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