| NPI | 1760708218 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID J RALLIS President/Owner 507-358-0974 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NE 6487) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 25504) |
| Enumeration Date | 2010-04-08 |
| Last Update Date | 2010-06-07 |