Healthcare Provider Details

I. General information

NPI: 1023038049
Provider Name (Legal Business Name): VALERIE L YANISZEWSKI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VALERIE L OPALA DMD

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6237 CAROLINA COMMONS DR STE 330
INDIAN LAND SC
29707-6014
US

IV. Provider business mailing address

855 HARVEST POINTE DR
FORT MILL SC
29708-7707
US

V. Phone/Fax

Practice location:
  • Phone: 803-547-9786
  • Fax: 803-547-6777
Mailing address:
  • Phone: 803-984-0682
  • Fax: 803-547-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3983
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: