MEDICARE: DR. SAMER SABBAGH DMD

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	12014092A	IN
2	122300000X	Dentist	019.032156	IL
3	1223P0300X	Periodontics	021003300	IL
4	122300000X	Dentist	10419	KY

General Provider Information

NPI Number	:	1356900419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMER SABBAGH DMD

Provider Business Mailing Address
First Line	:	9105A INDIANAPOLIS BLVD STE 201
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-2591
Country	:	US
Telephone Number	:	219-838-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	9105A INDIANAPOLIS BLVD STE 201
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-2591
Country	:	US
Telephone Number	:	219-838-6500
Fax Number	:

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

Provider Enumeration Date	:	06/11/2019
Last Update Date	:	03/02/2026

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