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NPI Code Detail

MEDICARE: RAVIKANTH R KALLU D.D.S.

MEDICARE: RAVIKANTH R KALLU D.D.S.
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDN013745GA

General Provider Information

NPI Number : 1447415179
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAVIKANTH R KALLU D.D.S.
Provider Business Mailing Address
First Line : PO BOX 1193
Second Line :
City : FORT VALLEY
State : GA
Zip : 31030-1193
Country : US
Telephone Number : 478-825-2001
Fax Number :
Provider Business Practice Location Address
First Line : 906 ORANGE ST
Second Line :
City : FORT VALLEY
State : GA
Zip : 31030-3456
Country : US
Telephone Number : 478-825-2001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2008
Last Update Date : 07/22/2008

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