| NPI | 1205213816 |
|---|---|
| Doing Business As | FONDREN FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | RAZA RAHGOZARD Dentist 210-777-1225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 29010) |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2015-05-04 |