Full Smile Dental Georgia, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

FULL SMILE DENTAL GEORGIA, PLLC

Doing business as

Full Smile Dental

Practice address

3609 S Georgia St
Amarillo, TX 79109-4847

Phone

(806) 641-1373

Fax

(806) 353-7077

NPI assigned

Jun 25, 2021

Organization subpart

No

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

Authorized official

Name

William Edward Graves, DMD

Title

Owner

Phone

(806) 641-1373

Specialties & licenses 1

Addresses

Other names 1

• Full Smile Dental Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1624579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624579200000",
    "number": "1851961643",
    "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": "806-641-1373",
            "fax_number": "806-353-7077"
        },
        {
            "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": "806-641-1373",
            "fax_number": "806-353-7077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL SMILE DENTAL GEORGIA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-25",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-07",
        "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": "806-641-1373",
        "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": "N",
            "endpointDescription": "Patient Email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "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"
        }
    ]
}

• Craig Frost
• Vikki Jill Frost, PHARM.D.
• Eddie Fuentes
• Ashley Nora Fulcher, NP
• Full Smile Dental Colonies, PLLC
• Full Smile Dental, PLLC
• Full Smile Dental, PLLC (Full Smile Dental)
• Full Smile Endodontics, PLLC
• Full Smile Periodontics, PLLC
• Full Smile Prosthodontics PLLC

• 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 Jun 25, 2021; 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.