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Organization

FOSSIL RIDGE FAMILY DENTISTRY PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. KRISHNA P COLLURU DDS (OWNER)
(201) 469-7076
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
24625
TX

Other

Enumeration date
05/19/2016
Last updated
05/19/2016
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