MEDICARE: HALETHORPE ORTHODONTICS, LLC

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
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry		MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346646379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALETHORPE ORTHODONTICS, LLC

Provider Business Mailing Address
First Line	:	4367 HOLLINS FERRY RD
Second Line	:	SUITE 1D
City	:	BALTIMORE
State	:	MD
Zip	:	21227-3400
Country	:	US
Telephone Number	:	410-565-6282
Fax Number	:	301-384-9877

Provider Business Practice Location Address
First Line	:	4367 HOLLINS FERRY RD
Second Line	:	SUITE 1D
City	:	BALTIMORE
State	:	MD
Zip	:	21227-3400
Country	:	US
Telephone Number	:	410-565-6282
Fax Number	:	301-384-9877

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RAVI KAUR
Credential	:	DDS
Telephone Number	:	410-565-6282

Provider Enumeration Date	:	11/19/2014
Last Update Date	:	11/19/2014

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Directions to “HALETHORPE ORTHODONTICS, LLC ” Practice Location

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