Organization
GRILL REPAIR, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN ELVEBAK (OWNER)
(817) 897-6006
Entity
Organization
Contact information
Practice address
1012 E ENNIS AVE, ENNIS, TX 75119-4345
(817) 897-6006
Mailing address
1012 E ENNIS AVE, ENNIS, TX 75119-4345
(817) 897-6006
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
20522
TX
Other
Enumeration date
03/04/2011
Last updated
03/04/2011
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