MEDICARE: DR. RAVI HALEKOTE DDS

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	122300000X	Dentist	17928	TX

General Provider Information

NPI Number	:	1588669147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAVI HALEKOTE DDS

Provider Business Mailing Address
First Line	:	16015 CHASE HILL BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78255-1153
Country	:	US
Telephone Number	:	210-695-4858
Fax Number	:

Provider Business Practice Location Address
First Line	:	2393 E SAUNDERS ST
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-5434
Country	:	US
Telephone Number	:	956-727-3980
Fax Number	:	956-727-4358

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/08/2007

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