| NPI | 1487952164 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN ELVEBAK Owner 817-897-6006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 20522) |
| Enumeration Date | 2011-03-04 |
| Last Update Date | 2011-03-04 |