# FOSSIL RIDGE FAMILY DENTISTRY PLLC

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

## Provider details

- **NPI number:** 1346697307
- **Authorized official:** DR. KRISHNA P COLLURU DDS (OWNER)
- **Authorized official phone:** (201) 469-7076

## Contact information

- **Practice address:** 3900 N TARRANT PKWY STE 100, FORT WORTH, TX 76244-5410
- **Practice address phone:** (201) 469-7076
- **Mailing address:** 7332 SAN FELIPE DR, IRVING, TX 75039-3356

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 24625 | TX | Yes |

## Other

- **Enumeration date:** 05/19/2016
- **Last updated:** 05/19/2016