MEDICARE: MICHAEL D. BETTNER, 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	1223G0001X	General Practice Dentistry	12010800A	IN

General Provider Information

NPI Number	:	1659543353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL D. BETTNER, DDS

Provider Business Mailing Address
First Line	:	14540 PRAIRIE LAKES BLVD N
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-4326
Country	:	US
Telephone Number	:	317-776-1300
Fax Number	:	317-776-2099

Provider Business Practice Location Address
First Line	:	14540 PRAIRIE LAKES BLVD N
Second Line	:	STE. 205
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-4366
Country	:	US
Telephone Number	:	317-776-1300
Fax Number	:	317-776-2099

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. GINA A ROSE
Credential	:
Telephone Number	:	317-776-1300

Provider Enumeration Date	:	04/02/2008
Last Update Date	:	06/23/2008

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