Provider Demographics
NPI:1851268981
Name:NICHOLAS RAKLIOS, DDS, PLLC
Entity type:Organization
Organization Name:NICHOLAS RAKLIOS, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PAYOR RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-267-8121
Mailing Address - Street 1:601 SE 117TH AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-5298
Mailing Address - Country:US
Mailing Address - Phone:360-450-2999
Mailing Address - Fax:360-335-6889
Practice Address - Street 1:601 SE 117TH AVE STE 150
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-5298
Practice Address - Country:US
Practice Address - Phone:360-450-2999
Practice Address - Fax:360-335-6889
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NICHOLAS RAKLIOS, DDS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty