NPIMap

Organization Active NPI

Grill Repair, PA

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Ennis, TX
National Provider Identifier
1487952164
Registry record updated Mar 4, 2011
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
Practice address
1012 E Ennis Ave
Ennis, TX 75119-4345
Phone
(817) 897-6006
NPI assigned
Mar 4, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2011

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

Authorized official

Name
Bryan Elvebak
Title
Owner
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

1012 E Ennis Ave
Ennis, TX 75119-4345

Mailing address

1012 E Ennis Ave
Ennis, TX 75119-4345
Phone (817) 897-6006

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": "1299196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299196800000",
    "number": "1487952164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 E ENNIS AVE",
            "city": "ENNIS",
            "state": "TX",
            "postal_code": "751194345",
            "telephone_number": "817-897-6006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 E ENNIS AVE",
            "city": "ENNIS",
            "state": "TX",
            "postal_code": "751194345",
            "telephone_number": "817-897-6006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRILL REPAIR, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-04",
        "last_updated": "2011-03-04",
        "status": "A",
        "authorized_official_last_name": "ELVEBAK",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "OWNER",
        "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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ennis, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2011; 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.