Healthcare Provider Details

I. General information

NPI: 1275401663
Provider Name (Legal Business Name): FREDERICKSBURG FAMILY DENTAL CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 FREDERICKSBURG ROAD, SUITE 101
SAN ANTONIO TX
78201
US

IV. Provider business mailing address

5800 N INTERSTATE 35 STE 205
DENTON TX
76207-1438
US

V. Phone/Fax

Practice location:
  • Phone: 210-898-8113
  • Fax:
Mailing address:
  • Phone: 940-220-7833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CRAIG COPELAND
Title or Position: DMD/OWNER
Credential: DMD
Phone: 940-220-7833