NPIMap

Organization Active NPI

Grill Repair, P.a.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Saginaw, TX
National Provider Identifier
1346560489
Registry record updated Jun 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
20522 Issued in TX
Legal business name
GRILL REPAIR, P.A.
Practice address
705 W Bailey Boswell Rd
Saginaw, TX 76179-1020
Phone
(817) 897-6006
NPI assigned
Jun 10, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bryan Elvebak
Title
Owner/Partner
Phone
(817) 897-6006

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223X0400X 20522 TX Primary

Addresses

Primary practice location

705 W Bailey Boswell Rd
Saginaw, TX 76179-1020

Mailing address

705 W Bailey Boswell Rd
Saginaw, TX 76179-1020

Other identifiers 1

IdentifierTypeStateIssuer
1033351408MedicaidTX

Other names 1

  • Saginaw Orthodontics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Grill Repair PA7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276560000000",
    "number": "1346560489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 W BAILEY BOSWELL RD",
            "city": "SAGINAW",
            "state": "TX",
            "postal_code": "761791020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 W BAILEY BOSWELL RD",
            "city": "SAGINAW",
            "state": "TX",
            "postal_code": "761791020",
            "telephone_number": "817-897-6006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRILL REPAIR, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-10",
        "last_updated": "2010-06-15",
        "status": "A",
        "authorized_official_last_name": "ELVEBAK",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "OWNER/PARTNER",
        "authorized_official_telephone_number": "817-897-6006"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TX",
            "license": "20522",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033351408",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Saginaw Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saginaw, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.