Healthcare Provider Details

I. General information

NPI: 1609207554
Provider Name (Legal Business Name): MARK F. YAMPOLSKY, DDS, MS DBA CAROLINA PERIODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1064 GARDNER RD SUITE #110
CHARLESTON SC
29407-5768
US

IV. Provider business mailing address

1064 GARDNER RD SUITE #110
CHARLESTON SC
29407-5768
US

V. Phone/Fax

Practice location:
  • Phone: 843-556-8778
  • Fax: 843-556-7003
Mailing address:
  • Phone: 843-556-8778
  • Fax: 843-556-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number6934
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2962
License Number StateSC

VIII. Authorized Official

Name: MARK F YAMPOLSKY
Title or Position: OWNER
Credential:
Phone: 843-556-8778