Provider Demographics
NPI:1396307310
Name:AL-CHAAR, LINA (DMD)
Entity type:Individual
Prefix:DR
First Name:LINA
Middle Name:
Last Name:AL-CHAAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 PRESTWICK PT
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-8515
Mailing Address - Country:US
Mailing Address - Phone:217-637-6874
Mailing Address - Fax:
Practice Address - Street 1:1428 TOWNE LAKE PKWY STE 99
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-8265
Practice Address - Country:US
Practice Address - Phone:678-203-2294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-29
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist