Full Smile Dental San Antonio Orthodontics, PLLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

FULL SMILE DENTAL SAN ANTONIO ORTHODONTICS, PLLC

Practice address

11330 Potranco Rd
San Antonio, TX 78253-7281

Phone

(210) 610-0117

NPI assigned

Dec 19, 2022

Organization subpart

No

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

Authorized official

Name

William Graves, DMD

Title

Owner

Phone

(210) 543-8000

Specialties & licenses 1

Addresses

Other names 1

• San Antonio Orthodontics Doing business as

Locations

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

{
    "created_epoch": "1671408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681776000000",
    "number": "1720790041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11330 POTRANCO RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782537281",
            "telephone_number": "210-610-0117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11330 POTRANCO RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782537281",
            "telephone_number": "210-610-0117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL SMILE DENTAL SAN ANTONIO ORTHODONTICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-19",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-18",
        "status": "A",
        "authorized_official_last_name": "GRAVES",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-543-8000",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Antonio Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "San Antonio Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 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.