| NPI | 1861094518 |
|---|---|
| Doing Business As | FUNDAMENTAL DENTAL |
| Entity Type | Organization |
| Authorized Contact | JACOB JOSE KRUVILLA Owner/Doctor 972-360-0096 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2020-11-09 |
| Last Update Date | 2020-11-09 |