# FOSSUM DENTAL GROUP

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

## Provider details

- **NPI number:** 1881807592
- **Authorized official:** DR. RCHARD FOSSUM D.D.S (ORGANIZER)
- **Authorized official phone:** (254) 778-3900

## Contact information

- **Practice address:** 201 W FM 2410 RD, HARKER HEIGHTS, TX 76548-1709
- **Practice address phone:** (254) 699-3565
- **Mailing address:** 2534 BLUE MEADOW DR, TEMPLE, TX 76502-7924
- **Mailing address phone:** (254) 778-3900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 22304 | TX | Yes |

## Other

- **Enumeration date:** 05/08/2007
- **Last updated:** 08/22/2020