Richard T. Provine, D.M.D

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1821 Issued in SC

Practice address

1111 W O Ezell Blvd
Ste.a
Spartanburg, SC 29301-1655

Phone

(864) 576-0943

Fax

(864) 576-7989

NPI assigned

Nov 1, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Charles S Bebko DMD PC

  • Dentist
  • Spartanburg, SC
  • NPI 1104372085
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210118400000",
    "number": "1811074735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 AMBER DR",
            "city": "INMAN",
            "state": "SC",
            "postal_code": "293499568",
            "telephone_number": "864-472-5708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 W O EZELL BLVD",
            "address_2": "STE.A",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293011655",
            "telephone_number": "864-576-0943",
            "fax_number": "864-576-7989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVINE",
        "first_name": "RICHARD",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2008-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "1821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Spartanburg, SC
• Providers in Spartanburg, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2008; 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.