Full Smile Periodontics, PLLC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

FULL SMILE PERIODONTICS, PLLC

Practice address

4515 Van Winkle Dr
Amarillo, TX 79119-6423

Phone

(806) 699-6111

Fax

(806) 353-7077

NPI assigned

May 2, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

William E Graves, DMD

Title

Owner

Phone

(806) 353-1055

Specialties & licenses 1

Addresses

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654214400000",
    "number": "1083359368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5051 S SONCY RD",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791196667",
            "telephone_number": "806-353-1055",
            "fax_number": "806-353-7077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4515 VAN WINKLE DR",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791196423",
            "telephone_number": "806-699-6111",
            "fax_number": "806-353-7077"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5051 S Soncy Rd",
            "address_purpose": "LOCATION",
            "city": "Amarillo",
            "state": "TX",
            "postal_code": "791196667",
            "country_code": "US",
            "telephone_number": "806-353-1055",
            "fax_number": "806-353-7077",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FULL SMILE PERIODONTICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-02",
        "last_updated": "2022-06-03",
        "certification_date": "2022-06-03",
        "status": "A",
        "authorized_official_last_name": "GRAVES",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "806-353-1055",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@fullsmiledental.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5051 S Soncy Rd",
            "city": "Amarillo",
            "state": "TX",
            "country_code": "US",
            "postal_code": "791196667",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Full Smile Dental Colonies, PLLC
• Full Smile Dental Georgia, PLLC (Full Smile Dental)
• Full Smile Dental, PLLC
• Full Smile Dental, PLLC (Full Smile Dental)
• Full Smile Endodontics, PLLC
• Full Smile Prosthodontics PLLC
• Heather Dawn Fuller-Jones, M.S. CFY-SLP
• Hailey Rene Fuller, PTA
• Stephen Fuller, DOCTOR OF CHIROPRACT
• Alton Wayne Funderburk Jr., CRNA

• Periodontics in Amarillo, TX
• Providers in Amarillo, TX by specialty
• Periodontics in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.