Fondren Dental PA

Primary specialty

DentistTaxonomy code 122300000X

License

29010 Issued in TX

Legal business name

FONDREN DENTAL PA

Doing business as

Fondren Family Dental

Practice address

3400 Fondren Rd
Houston, TX 77063

Phone

(281) 974-3850

NPI assigned

May 4, 2015

Last updated

May 4, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Raza Rahgozard

Title

Dentist

Phone

(210) 777-1225

Specialties & licenses 1

Addresses

Other names 1

• FONDREN FAMILY DENTAL Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430697600000",
    "number": "1205213816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 FONDREN RD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770635650",
            "telephone_number": "281-974-3850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 FONDREN RD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77063",
            "telephone_number": "281-974-3850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FONDREN DENTAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-04",
        "last_updated": "2015-05-04",
        "status": "A",
        "authorized_official_last_name": "RAHGOZARD",
        "authorized_official_first_name": "RAZA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "210-777-1225",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "29010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FONDREN FAMILY DENTAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kenneth Fomulu, MD
• Clyde Fomunung, MD
• Pamela Y Fomunung, RPH
• Esther T Fon
• Fondren Advanced Care PLLC
• Fondren Dialysis Clinic, Inc. (Fresenius Kidney Care of Fondren Dialysis)
• Fondren Elite Orthopedics PLLC
• Fondren Health Group Inc
• Fondren MD Center LLC
• Fondren Orthopedic Care PLLC

• Dentist in Houston, TX
• Providers in Houston, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.