NPIMap

Organization Active NPI

Foothills Oral & Facial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Anderson, SC
National Provider Identifier
1134549629
Registry record updated Apr 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
4084 Issued in SC
Legal business name
FOOTHILLS ORAL & FACIAL SURGERY
Practice address
301 W Beltline Blvd
#301
Anderson, SC 29625-1505
Phone
(864) 967-4000
Fax
(864) 328-9907
NPI assigned
Apr 23, 2014
Last updated
Apr 23, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Victor P Lebedovych, DDSNPI 1104849314
Title
President/Ceo
Phone
(864) 967-4000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 4084 SC Primary

Addresses

Primary practice location

301 W Beltline Blvd
#301
Anderson, SC 29625-1505

Mailing address

301 W Beltline Blvd
#301
Anderson, SC 29625-1505
Phone (864) 967-4000

Other identifiers 1

IdentifierTypeStateIssuer
1223S0112XMedicaidSC

National Provider Directory

National Provider Directory
Tax ID family
Foothills Oral Facial Surgery2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

301 W Beltline Blvd
#301
Anderson, SC 29625
Phone (864) 967-4000

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398211200000",
    "number": "1134549629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 W BELTLINE BLVD",
            "address_2": "#301",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "296251505",
            "telephone_number": "864-967-4000",
            "fax_number": "864-328-9907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 W BELTLINE BLVD",
            "address_2": "#301",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "296251505",
            "telephone_number": "864-967-4000",
            "fax_number": "864-328-9907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOTHILLS ORAL & FACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-23",
        "last_updated": "2014-04-23",
        "status": "A",
        "authorized_official_last_name": "LEBEDOVYCH",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "864-967-4000",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "SC",
            "license": "4084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1223S0112X",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anderson, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.