Healthcare Provider Details

I. General information

NPI: 1528211273
Provider Name (Legal Business Name): RALLIS ORTHODONTICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3256 SALT CREEK CIR.
LINCOLN NE
68504
US

IV. Provider business mailing address

3256 SALT CREEK CIR.
LINCOLN NE
68504
US

V. Phone/Fax

Practice location:
  • Phone: 402-742-3000
  • Fax:
Mailing address:
  • Phone: 402-742-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6647
License Number StateNE

VIII. Authorized Official

Name: DR. PAUL J RALLIS
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 402-730-6838