Provider Demographics
NPI:1912356411
Name:NICHOLAS RAKLIOS, DDS, PLLC
Entity Type:Organization
Organization Name:NICHOLAS RAKLIOS, DDS, PLLC
Other - Org Name:CASCADIA KIDS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:RAKLIOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-508-5946
Mailing Address - Street 1:13034 SE KENT KANGLEY RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7965
Mailing Address - Country:US
Mailing Address - Phone:425-301-2270
Mailing Address - Fax:
Practice Address - Street 1:13034 SE KENT KANGLEY RD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-7965
Practice Address - Country:US
Practice Address - Phone:425-301-2270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 605579381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty