Provider Demographics
NPI:1457483505
Name:RALLI, BRIAN KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KENNETH
Last Name:RALLI
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 1:7456 FOOTHILLS BLVD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-6560
Mailing Address - Country:US
Mailing Address - Phone:916-773-0800
Mailing Address - Fax:916-773-0835
Practice Address - Street 1:7456 FOOTHILLS BLVD
Practice Address - Street 2:SUITE 14
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-6560
Practice Address - Country:US
Practice Address - Phone:916-773-0800
Practice Address - Fax:916-773-0835
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA477831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice