NPIMap

Organization Active NPI

Fossil Ridge Family Dentistry PLLC

  • General Practice Dentistry
  • Fort Worth, TX
National Provider Identifier
1326585274
Registry record updated Jan 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
24625 Issued in TX
Legal business name
FOSSIL RIDGE FAMILY DENTISTRY PLLC
Practice address
3900 N Tarrant Pkwy Ste 100
Fort Worth, TX 76244-5410
Phone
(817) 379-9091
NPI assigned
Jan 30, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2017

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

Authorized official

Name
Dr. Krishna Colluru, DDSNPI 1750539490
Title
Owner
Phone
(817) 379-9091

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 24625 TX Primary
ProsthodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0700X 31537 TX

Addresses

Primary practice location

3900 N Tarrant Pkwy Ste 100
Fort Worth, TX 76244-5410

Mailing address

3900 N Tarrant Pkwy Ste 100
Fort Worth, TX 76244-5410
Phone (817) 379-9091

National Provider Directory

National Provider Directory
Tax ID family
Fossil Ridge Family Dentistry PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3900 North Tarrant Pkwy
Ste 100
Fort Worth, TX 76244
Phone (201) 469-7076

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1485734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485734400000",
    "number": "1326585274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 N TARRANT PKWY STE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762445410",
            "telephone_number": "817-379-9091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 N TARRANT PKWY STE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762445410",
            "telephone_number": "817-379-9091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOSSIL RIDGE FAMILY DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-30",
        "last_updated": "2017-01-30",
        "status": "A",
        "authorized_official_last_name": "COLLURU",
        "authorized_official_first_name": "KRISHNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-379-9091",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "24625",
            "primary": true
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": "TX",
            "license": "31537",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2017; 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.