NPIMap

Organization Active NPI

Grill Repair, P.a.

Doing business as Orthodontics at the Dental and Implant Suite

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Hurst, TX
National Provider Identifier
1831490226
Registry record updated Mar 2, 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, P.A.
Doing business as
Orthodontics at the Dental and Implant Suite
Practice address
458 Mid Cities Blvd
Hurst, TX 76054-2430
Phone
(817) 571-2100
NPI assigned
Nov 16, 2010
Last updated
Mar 2, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2011

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) 571-2100

Specialties & licenses 1

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

Addresses

Primary practice location

458 Mid Cities Blvd
Hurst, TX 76054-2430

Mailing address

458 Mid Cities Blvd
Hurst, TX 76054-2430
Phone (817) 571-2100

Other names 1

  • Orthodontics at the Dental and Implant Suite 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

458 Mid Cities Blvd
Hurst, TX 76054
Phone (817) 571-2100

NPI Registry JSON

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

{
    "created_epoch": "1289865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299024000000",
    "number": "1831490226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "458 MID CITIES BLVD",
            "city": "HURST",
            "state": "TX",
            "postal_code": "760542430",
            "telephone_number": "817-571-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "458 MID CITIES BLVD",
            "city": "HURST",
            "state": "TX",
            "postal_code": "760542430",
            "telephone_number": "817-571-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRILL REPAIR, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-16",
        "last_updated": "2011-03-02",
        "status": "A",
        "authorized_official_last_name": "ELVEBAK",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "OWNER/PARTNER",
        "authorized_official_telephone_number": "817-571-2100"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TX",
            "license": "20522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Orthodontics at the Dental and Implant Suite",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hurst, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 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.