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Organization

FOOTHILLS ORAL & FACIAL SURGERY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
VICTOR P LEBEDOVYCH DDS (PRESIDENT/CEO)
(864) 967-4000
Entity
Organization

Contact information

Practice address
301 W BELTLINE BLVD, #301, ANDERSON, SC 29625-1505
(864) 967-4000
(864) 328-9907
Mailing address
301 W BELTLINE BLVD, #301, ANDERSON, SC 29625-1505
(864) 967-4000
(864) 328-9907

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
4084
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1223S0112X
SC
Enumeration date
04/23/2014
Last updated
04/23/2014
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