# FOSSUM DENTAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Benchmark Family Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699088666
- **Authorized official:** RICHARD F FOSSUM DDS (OWNER)
- **Authorized official phone:** (254) 778-3900

## Contact information

- **Practice address:** 806 E AVENUE D, SUITE C, COPPERAS COVE, TX 76522-2284
- **Practice address phone:** (254) 547-4866
- **Mailing address:** 806 E AVENUE D, SUITE C, COPPERAS COVE, TX 76522-2284
- **Mailing address phone:** (254) 547-4866

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 19639 | TX | Yes |

## Other

- **Enumeration date:** 07/20/2010
- **Last updated:** 07/20/2010