Full Smile Dental, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

FULL SMILE DENTAL, PLLC

Doing business as

Full Smile Dental

Practice address

3609 S Georgia St
Amarillo, TX 79109-4847

Phone

(806) 353-1055

Fax

(806) 353-1055

NPI assigned

Apr 8, 2020

Organization subpart

No

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

Authorized official

Name

Jennifer Lynn Williams

Title

Credentialing

Phone

(806) 803-9452

Specialties & licenses 1

Addresses

Other names 1

• Full Smile Dental Doing business as

Electronic endpoints 1

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.

• Full Smile Dental, PLLC

  • General Practice Dentistry
  • Amarillo, TX
  • NPI 1548872542
  NPD tax ID
• Full Smile Dental, PLLC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Farwell, TX
  • NPI 1558964536
  NPD tax ID

Locations

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

{
    "created_epoch": "1586304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1699394833",
    "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": "806-353-1077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3609 S GEORGIA ST",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791094847",
            "telephone_number": "806-353-1055",
            "fax_number": "806-353-1055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL SMILE DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-08",
        "last_updated": "2023-11-27",
        "certification_date": "2020-04-08",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "806-803-9452"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@amarillooralsurgery.com",
            "affiliation": "Y",
            "endpointDescription": "Email",
            "affiliationName": "Amarillo Oral Surgery, LLC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3609 S Georgia St",
            "city": "Amarillo",
            "state": "TX",
            "country_code": "US",
            "postal_code": "791094847",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Full Smile Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Eddie Fuentes
• Ashley Nora Fulcher, NP
• Full Smile Dental Colonies, PLLC
• Full Smile Dental Georgia, PLLC (Full Smile Dental)
• Full Smile Dental, PLLC
• Full Smile Endodontics, PLLC
• Full Smile Periodontics, PLLC
• Full Smile Prosthodontics PLLC
• Heather Dawn Fuller-Jones, M.S. CFY-SLP
• Hailey Rene Fuller, PTA

• General Practice Dentistry in Amarillo, TX
• Providers in Amarillo, TX by specialty
• General Practice Dentistry in Texas

• 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.