# FOSSIL RIDGE FAMILY DENTISTRY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326585274
- **Authorized official:** DR. KRISHNA COLLURU DDS (OWNER)
- **Authorized official phone:** (817) 379-9091

## Contact information

- **Practice address:** 3900 N TARRANT PKWY STE 100, FORT WORTH, TX 76244-5410
- **Practice address phone:** (817) 379-9091
- **Mailing address:** 3900 N TARRANT PKWY STE 100, FORT WORTH, TX 76244-5410
- **Mailing address phone:** (817) 379-9091

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 24625 | TX | Yes |
| 1223P0700X | Prosthodontics | 31537 | TX | — |

## Other

- **Enumeration date:** 01/30/2017
- **Last updated:** 01/30/2017