MEDICARE: RALLIS DENTISTRY OF BAYSIDE,PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223G0001X	General Practice Dentistry
2	1223P0300X	Periodontics
3	1223P0106X	Oral and Maxillofacial Pathology Dentistry

General Provider Information

NPI Number	:	1578684866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RALLIS DENTISTRY OF BAYSIDE,PLLC

Provider Business Mailing Address
First Line	:	20920 35TH AVE
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-1429
Country	:	US
Telephone Number	:	718-631-7800
Fax Number	:	718-631-4949

Provider Business Practice Location Address
First Line	:	20920 35TH AVE
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-1429
Country	:	US
Telephone Number	:	718-631-7800
Fax Number	:	718-631-4949

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. NICHOLAS I. RALLIS
Credential	:	D.D.S.
Telephone Number	:	718-631-7800

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	09/11/2025

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