Provider Demographics
NPI:1659543353
Name:MICHAEL D. BETTNER, DDS
Entity Type:Organization
Organization Name:MICHAEL D. BETTNER, DDS
Other - Org Name:MICHAEL BETTNER FAMILY & COSMETIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-776-1300
Mailing Address - Street 1:14540 PRAIRIE LAKES BLVD N
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4326
Mailing Address - Country:US
Mailing Address - Phone:317-776-1300
Mailing Address - Fax:317-776-2099
Practice Address - Street 1:14540 PRAIRIE LAKES BLVD N
Practice Address - Street 2:STE. 205
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4366
Practice Address - Country:US
Practice Address - Phone:317-776-1300
Practice Address - Fax:317-776-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010800A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty