NPIMap

Organization Active NPI

Grill Repair PA

Doing business as Red River Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Wichita Falls, TX
National Provider Identifier
1467770073
Registry record updated May 6, 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 PA
Doing business as
Red River Orthodontics
Practice address
1 Eureka Cir Ste 103
Wichita Falls, TX 76308-2929
Phone
(469) 522-3306
NPI assigned
May 6, 2010
Last updated
May 6, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2010

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

Authorized official

Name
Bryna Elvebak
Title
Partner
Phone
(469) 522-3306

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 20522 TX Primary

Addresses

Primary practice location

1 Eureka Cir Ste 103
Wichita Falls, TX 76308-2929

Mailing address

7134 Campbell Rd Ste B
Dallas, TX 75248-1564
Phone (469) 522-3306

Other names 1

  • Red River 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.

Locations

7134 Campbell Rd
Ste B
Dallas, TX 75248

1 Eureka Cir
Ste 103
Wichita Falls, TX 76308
Phone (469) 522-3306

NPI Registry JSON

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

{
    "created_epoch": "1273104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273104000000",
    "number": "1467770073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7134 CAMPBELL RD STE B",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752481564",
            "telephone_number": "469-522-3306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 EUREKA CIR STE 103",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763082929",
            "telephone_number": "469-522-3306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRILL REPAIR PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-06",
        "last_updated": "2010-05-06",
        "status": "A",
        "authorized_official_last_name": "ELVEBAK",
        "authorized_official_first_name": "BRYNA",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "469-522-3306"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TX",
            "license": "20522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Red River Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wichita Falls, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 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.