Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery | |
Oral and Maxillofacial Surgery |
1223S0112X | 19 | Oral Surgery (Dentist only) |
| NPI Number | 1760708218 |
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| LBN Legal business name | DAVID J RALLIS DDS MD ORAL AND MAXILLOFACIAL SURGERY, PC | ||||||||||||
| Authorized official | DAVID RALLIS - (PRESIDENT/OWNER) | ||||||||||||
| Entity | Organization | ||||||||||||
| Organization subpart 1 | No | ||||||||||||
| Enumeration date | 04/08/2010 | ||||||||||||
| Last updated | 06/07/2010 - About 16 years ago | ||||||||||||
| Identifiers |
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