NPIMap

Organization Active NPI

Full Smile Dental Boerne Orthodontics, PLLC

  • General Practice Dentistry
  • Boerne, TX
National Provider Identifier
1215648340
Registry record updated Dec 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
FULL SMILE DENTAL BOERNE ORTHODONTICS, PLLC
Practice address
215 W Bandera Rd Ste 112
Boerne, TX 78006-2842
Phone
(806) 353-1055
NPI assigned
Dec 9, 2022
Last updated
Dec 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2022

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

Authorized official

Name
William Graves, DMDNPI 1568686905
Title
Owner
Phone
(806) 353-1055

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary
Pediatric Dentistry 1223P0221X NU
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X NU

Addresses

Primary practice location

215 W Bandera Rd Ste 112
Boerne, TX 78006-2842

Mailing address

5051 S Soncy Rd
Amarillo, TX 79119-6667
Phone (806) 353-1055

National Provider Directory

National Provider Directory
Tax ID family
Full Smile Dental Boerne Orthodontics 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.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1670544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670544000000",
    "number": "1215648340",
    "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": "215 W BANDERA RD STE 112",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780062842",
            "telephone_number": "806-353-1055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL SMILE DENTAL BOERNE ORTHODONTICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-09",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-09",
        "status": "A",
        "authorized_official_last_name": "GRAVES",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "806-353-1055",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boerne, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 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.