Organization
GRILL REPAIR PA
Active
Other names
Red River Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
BRYNA ELVEBAK (PARTNER)
(469) 522-3306
Entity
Organization
Contact information
Practice address
1 EUREKA CIR STE 103, WICHITA FALLS, TX 76308-2929
(469) 522-3306
Mailing address
7134 CAMPBELL RD STE B, DALLAS, TX 75248-1564
(469) 522-3306
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
20522
TX
Other
Enumeration date
05/06/2010
Last updated
05/06/2010
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