Organization
GRILL REPAIR, P. A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN ELVEBAK (PARTNER)
(940) 484-5437
Entity
Organization
Contact information
Practice address
6225 CHAPEL HILL BLVD, PLANO, TX 75093-6392
(817) 897-6006
Mailing address
PO BOX 161971, FORT WORTH, TX 76161-1971
(817) 897-6006
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
20522
TX
Other
Enumeration date
11/16/2010
Last updated
11/16/2010
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