Healthcare Provider Details

I. General information

NPI: 1295221364
Provider Name (Legal Business Name): CRAIG LUSTMAN DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8903 GLADES RD STE D4
BOCA RATON FL
33434-4023
US

IV. Provider business mailing address

8903 GLADES RD STE D4
BOCA RATON FL
33434-4023
US

V. Phone/Fax

Practice location:
  • Phone: 561-483-9334
  • Fax:
Mailing address:
  • Phone: 561-483-9334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIFFANI BERNSTEIN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 954-707-2541