MEDICARE: LINA AL-BITAR DDS 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	122300000X	Dentist	12008789A	IN
2	124Q00000X	Dental Hygienist	12008789A	IN
3	122300000X	Dentist	12011375A	IN

General Provider Information

NPI Number	:	1902293640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINA AL-BITAR DDS LLC

Provider Business Mailing Address
First Line	:	8001 E 10TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-5240
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8001 E 10TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-5240
Country	:	US
Telephone Number	:	317-897-5787
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. LINA AL-BITAR
Credential	:	DDS
Telephone Number	:	317-897-5787

Provider Enumeration Date	:	04/21/2015
Last Update Date	:	04/22/2015

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