Healthcare Provider Details

I. General information

NPI: 1861397994
Provider Name (Legal Business Name): FULL SMILE VISCOUNT ENDODONTIC GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9398 VISCOUNT BLVD STE 4B
EL PASO TX
79925-8028
US

IV. Provider business mailing address

2201 CIVIC CIR STE 600
AMARILLO TX
79109-1844
US

V. Phone/Fax

Practice location:
  • Phone: 915-595-1399
  • Fax:
Mailing address:
  • Phone: 806-353-1055
  • Fax: 806-243-1770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number StateNULL

VIII. Authorized Official

Name: WILLIAM E. GRAVES
Title or Position: OWNER
Credential: DMD
Phone: 806-381-3435