Provider Demographics
NPI:1316654320
Name:RALLS, ERICA (RDH,BSDH,CDHC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:RALLS
Suffix:
Gender:F
Credentials:RDH,BSDH,CDHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 NASH RD
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-3819
Mailing Address - Country:US
Mailing Address - Phone:618-697-9846
Mailing Address - Fax:
Practice Address - Street 1:7562 OLD ROUTE 13
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-7776
Practice Address - Country:US
Practice Address - Phone:618-993-8333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist