Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 617 | SC |
NPI | 1104849314 |
---|---|
Provider Name | Dr. Victor Paul Lebedovych |
First Address | Simspnville, SC 29680 |
Second Address | Simspnville, SC 29680 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |