| NPI | 1750682142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN ELVEBAK Partner 940-484-5437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 20522) |
| Enumeration Date | 2010-11-16 |
| Last Update Date | 2010-11-16 |