Provider Demographics
NPI:1265439699
Name:ELVEBAK ORTHODONTICS, PA
Entity type:Organization
Organization Name:ELVEBAK ORTHODONTICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:ELVEBAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:972-931-2700
Mailing Address - Street 1:6225 CHAPEL HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6392
Mailing Address - Country:US
Mailing Address - Phone:972-931-2700
Mailing Address - Fax:972-931-2703
Practice Address - Street 1:6225 CHAPEL HILL BLVD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6392
Practice Address - Country:US
Practice Address - Phone:972-931-2700
Practice Address - Fax:972-931-2703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty