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General NPI Number Information
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NPI Number | 1861397994
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Entity Type | Organization
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Legal Business Name | FULL SMILE VISCOUNT ENDODONTIC GROUP, PLLC
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Dates
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Enumeration Date | 10/09/2026
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Last Update Date | 10/09/2026
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Provider Practice Location Address
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Address Line | 9398 VISCOUNT BLVD STE 4B
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City | EL PASO
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State | TX
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Zip | 79925-8028
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Country | US
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Telephone | 915-595-1399
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 CIVIC CIR STE 600
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City | AMARILLO
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State | TX
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Zip | 79109-1844
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Country | US
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Telephone | 806-353-1055
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Fax | 806-243-1770
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM E. GRAVES
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Credential | DMD
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Telephone | 806-381-3435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State | NULL
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