Organization
GRILL REPAIR, P.A.
Active
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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