Organization
FOSSUM DENTAL GROUP
Active
Other names
Benchmark Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD F FOSSUM DDS (OWNER)
(254) 778-3900
Entity
Organization
Contact information
Practice address
806 E AVENUE D, SUITE C, COPPERAS COVE, TX 76522-2284
(254) 547-4866
Mailing address
806 E AVENUE D, SUITE C, COPPERAS COVE, TX 76522-2284
(254) 547-4866
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19639
TX
Other
Enumeration date
07/20/2010
Last updated
07/20/2010
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