Provider Demographics
NPI:1033351408
Name:ELVEBAK, BRYAN (DDS)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:ELVEBAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
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:
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics