Provider Demographics
NPI:1487222725
Name:NICHOLAS RAKLIOS, DDS, PLLC
Entity Type:Organization
Organization Name:NICHOLAS RAKLIOS, DDS, PLLC
Other - Org Name:PRISTERA ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PAYOR RELATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-267-8121
Mailing Address - Street 1:350 S 38TH CT STE 215
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5777
Mailing Address - Country:US
Mailing Address - Phone:208-918-8075
Mailing Address - Fax:
Practice Address - Street 1:350 S 38TH CT STE 215
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5777
Practice Address - Country:US
Practice Address - Phone:208-918-8075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty