Full Smile Dental Lakeridge, PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

FULL SMILE DENTAL LAKERIDGE, PLLC

Practice address

4425 98TH St
Lubbock, TX 79424-5029

Phone

(806) 641-1373

Fax

(806) 353-7077

NPI assigned

Nov 3, 2021

Organization subpart

No

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

Authorized official

Name

Jennifer Lynn Morris

Title

Credentialing Specialist

Phone

(806) 353-1055

Specialties & licenses 3

Addresses

Other names 1

• Full Smile Dental Lakeridge, PLLC Former legal business name

Electronic endpoints 2

Tax ID family

Full Smile Dental Lakeridge PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Lubbock Dental Specialists, PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Plainview, TX
  • NPI 1689426397
  NPD tax ID

Locations

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

{
    "created_epoch": "1635897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645660800000",
    "number": "1184389355",
    "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": "4425 98TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794245029",
            "telephone_number": "806-641-1373",
            "fax_number": "806-353-7077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL SMILE DENTAL LAKERIDGE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-03",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "806-353-1055"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "info@fullsmiledental.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4425 98th St",
            "city": "Lubbock",
            "state": "TX",
            "country_code": "US",
            "postal_code": "794245029",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "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": "4425 98th St",
            "city": "Lubbock",
            "state": "TX",
            "country_code": "US",
            "postal_code": "794245029",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Full Smile Dental Lakeridge, PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Full Smile Dental Lakeridge, PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Trevor Jerrod Fugate, AGACNP-BC
• Sarah Fuhrmeister, LPC ASSOCIATE
• Brandie Fulbright
• Connie Fulbright
• Victor Ray Fulford, NA
• Addison Fuller
• Amber Rae Fuller, PTA
• Anthony Raymond Fuller, CRNA
• Christopher G. Fuller, M.D.
• Courtney Carole Fuller, BSN, RN

• Oral and Maxillofacial Surgery (Dentist) in Lubbock, TX
• Providers in Lubbock, TX by specialty
• Oral and Maxillofacial Surgery (Dentist) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 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.