Provider Demographics
NPI:1942530910
Name:DAVID L FLEITAS DDS PLLC
Entity Type:Organization
Organization Name:DAVID L FLEITAS DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:FLEITAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:830-779-3013
Mailing Address - Street 1:PO BOX 200698
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78220
Mailing Address - Country:US
Mailing Address - Phone:830-779-3013
Mailing Address - Fax:
Practice Address - Street 1:101 JUNIORS PL
Practice Address - Street 2:
Practice Address - City:LA VERNIA
Practice Address - State:TX
Practice Address - Zip Code:78121-4886
Practice Address - Country:US
Practice Address - Phone:830-779-3013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX177091223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty