NPIMap

Organization Active NPI

Full Smile Dental, PLLC

  • General Practice Dentistry
  • Amarillo, TX
National Provider Identifier
1548872542
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
FULL SMILE DENTAL, PLLC
Practice address
4515 Van Winkle Dr
Amarillo, TX 79119-6423
Phone
(806) 358-0368
Fax
(806) 353-7077
NPI assigned
Aug 20, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Authorized official

Name
Dr. William Edward Graves, DMD
Title
Owner
Phone
(806) 353-1055

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

4515 Van Winkle Dr
Amarillo, TX 79119-6423

Mailing address

5051 S Soncy Rd
Amarillo, TX 79119-6667
Phone (063) 531-0558

Other names 1

  • Full Smile Dental, PLLC Former legal business name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address info@fullsmiledental.com Direct Full Smile Dental, PLLC

National Provider Directory

National Provider Directory
Tax ID family
Full Smile Dental PLLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1597881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1548872542",
    "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": "063-531-0558",
            "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": "806-358-0368",
            "fax_number": "806-353-7077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL SMILE DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-20",
        "last_updated": "2023-11-27",
        "certification_date": "2020-08-20",
        "status": "A",
        "authorized_official_last_name": "GRAVES",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "806-353-1055",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@fullsmiledental.com",
            "affiliation": "Y",
            "endpointDescription": "Email",
            "affiliationName": "Full Smile Dental, PLLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4515 Van Winkle Dr",
            "city": "Amarillo",
            "state": "TX",
            "country_code": "US",
            "postal_code": "791196423",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Full Smile Dental, PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Amarillo, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.