Provider Demographics
NPI:1316334113
Name:LAS PALMAS DENTAL, PLLC
Entity type:Organization
Organization Name:LAS PALMAS DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:FLEMING
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-220-7833
Mailing Address - Street 1:PO BOX 674330
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4330
Mailing Address - Country:US
Mailing Address - Phone:940-808-1970
Mailing Address - Fax:855-731-5147
Practice Address - Street 1:810 S GENERAL MCMULLEN DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-3111
Practice Address - Country:US
Practice Address - Phone:940-808-1970
Practice Address - Fax:855-731-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX276381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty