MEDICARE: DR. CHARLES S. BEBKO D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2390	SC

General Provider Information

NPI Number	:	1093718009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES S. BEBKO D.M.D.

Provider Business Mailing Address
First Line	:	1111 W O EZELL BLVD
Second Line	:	STE. B
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-1655
Country	:	US
Telephone Number	:	864-576-0947
Fax Number	:	864-576-7989

Provider Business Practice Location Address
First Line	:	1111 W O EZELL BLVD
Second Line	:	STE. B
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-1655
Country	:	US
Telephone Number	:	864-576-0947
Fax Number	:	864-576-7989

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	05/07/2008

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