Organization
FOSSIL RIDGE FAMILY DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KRISHNA COLLURU DDS (OWNER)
(817) 379-9091
Entity
Organization
Contact information
Practice address
3900 N TARRANT PKWY STE 100, FORT WORTH, TX 76244-5410
(817) 379-9091
Mailing address
3900 N TARRANT PKWY STE 100, FORT WORTH, TX 76244-5410
(817) 379-9091
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
24625
TX
1223P0700X
Prosthodontics
31537
TX
Other
Enumeration date
01/30/2017
Last updated
01/30/2017
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