Provider Demographics
NPI:1528211273
Name:RALLIS ORTHODONTICS, PC
Entity Type:Organization
Organization Name:RALLIS ORTHODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RALLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-730-6838
Mailing Address - Street 1:3256 SALT CREEK CIR.
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504
Mailing Address - Country:US
Mailing Address - Phone:402-742-3000
Mailing Address - Fax:
Practice Address - Street 1:3256 SALT CREEK CIR.
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504
Practice Address - Country:US
Practice Address - Phone:402-742-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE66471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty