Provider Demographics
NPI:1346646379
Name:HALETHORPE ORTHODONTICS, LLC
Entity Type:Organization
Organization Name:HALETHORPE ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-565-6282
Mailing Address - Street 1:4367 HOLLINS FERRY RD
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-3400
Mailing Address - Country:US
Mailing Address - Phone:410-565-6282
Mailing Address - Fax:301-384-9877
Practice Address - Street 1:4367 HOLLINS FERRY RD
Practice Address - Street 2:SUITE 1D
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-3400
Practice Address - Country:US
Practice Address - Phone:410-565-6282
Practice Address - Fax:301-384-9877
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:M&R DENTAL ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD039215400Medicaid