Provider Demographics
NPI:1104849314
Name:LEBEDOVYCH, VICTOR PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:PAUL
Last Name:LEBEDOVYCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 FAIRVIEW RD
Mailing Address - Street 2:BUILDING C
Mailing Address - City:SIMSPNVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680
Mailing Address - Country:US
Mailing Address - Phone:864-967-4000
Mailing Address - Fax:
Practice Address - Street 1:634 FAIRVIEW RD
Practice Address - Street 2:BUILDING C
Practice Address - City:SIMSPNVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680
Practice Address - Country:US
Practice Address - Phone:864-967-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6171223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery