Full Smile Dental Prosper Trail Orthodontics, PLLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

FULL SMILE DENTAL PROSPER TRAIL ORTHODONTICS, PLLC

Practice address

821 N Coleman St Ste 110
Prosper, TX 75078-2305

Phone

(972) 347-1700

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

(806) 353-1055

Specialties & licenses 1

Addresses

Other names 1

• Prosper Trail Orthodontics Doing business as

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• James Robert Vandeberg, D.D.S, M.S.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • San Antonio, TX
  • NPI 1750562021
  NPD

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

{
    "created_epoch": "1671408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671408000000",
    "number": "1891407110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "821 N COLEMAN ST STE 110",
            "city": "PROSPER",
            "state": "TX",
            "postal_code": "750782305",
            "telephone_number": "972-347-1700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 N COLEMAN ST STE 110",
            "city": "PROSPER",
            "state": "TX",
            "postal_code": "750782305",
            "telephone_number": "972-347-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL SMILE DENTAL PROSPER TRAIL ORTHODONTICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-19",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "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": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "info@fullsmiledental.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "821 N Coleman St Ste 110",
            "city": "Prosper",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750782305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Prosper Trail Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Eric Ryan Friedrich, D.O.
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• Rachel Elizabeth Fritz, OTD, OTR/L
• Brandon Fry, ATP
• Ally Renee Funkhouser Dye, CPNP
• Allison Gage
• Bianca Michele Galante, LCSW
• Samantha Eileen Galui
• Jeannine Monique Gambles, LMFT

• Orthodontics and Dentofacial Orthopedics Dentistry in Prosper, TX
• Providers in Prosper, 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 Dec 19, 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.