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General NPI Number Information
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NPI Number | 1528211273
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Entity Type | Organization
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Legal Business Name | RALLIS ORTHODONTICS, PC
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 3256 SALT CREEK CIR.
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City | LINCOLN
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State | NE
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Zip | 68504
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Country | US
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Telephone | 402-742-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 3256 SALT CREEK CIR.
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City | LINCOLN
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State | NE
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Zip | 68504
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Country | US
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Telephone | 402-742-3000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL J RALLIS
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Credential | D.D.S.
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Telephone | 402-730-6838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 6647
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License Number State | NE
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