Organization
GRILL REPAIR, P.A.
Active
Other names
Orthodontics at the Dental and Implant Suite
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN ELVEBAK (OWNER/PARTNER)
(817) 571-2100
Entity
Organization
Contact information
Practice address
458 MID CITIES BLVD, HURST, TX 76054-2430
(817) 571-2100
Mailing address
458 MID CITIES BLVD, HURST, TX 76054-2430
(817) 571-2100
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
20522
TX
Other
Enumeration date
11/16/2010
Last updated
03/02/2011
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