Provider Demographics
NPI:1902293640
Name:LINA AL-BITAR DDS LLC
Entity Type:Organization
Organization Name:LINA AL-BITAR DDS LLC
Other - Org Name:GRAY FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINA
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-BITAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-897-5787
Mailing Address - Street 1:8001 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-5240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8001 E 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-5240
Practice Address - Country:US
Practice Address - Phone:317-897-5787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011375A122300000X
IN12008789A122300000X, 124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty