Organization
GRILL REPAIR, P.A.
Active
Other names
Saginaw Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN ELVEBAK (OWNER/PARTNER)
(817) 897-6006
Entity
Organization
Contact information
Practice address
705 W BAILEY BOSWELL RD, SAGINAW, TX 76179-1020
(817) 897-6006
Mailing address
705 W BAILEY BOSWELL RD, SAGINAW, TX 76179-1020
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
20522
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033351408
—
TX
Enumeration date
06/10/2010
Last updated
06/15/2010
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