MEDICARE: CHARLES S BEBKO DMD PC

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	122300000X	Dentist	30-2390	SC

General Provider Information

NPI Number	:	1104372085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES S BEBKO DMD PC

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

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHARLES S BEBKO
Credential	:	DMD
Telephone Number	:	864-576-0947

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	08/30/2016

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