Healthcare Provider Details

I. General information

NPI: 1346489564
Provider Name (Legal Business Name): VALERIE L. YANISZEWSKI, DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6237 CAROLINA COMMONS DR SUITE 301
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:

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: DR. VALERIE LAUREN YANISZEWSKI
Title or Position: OWNER
Credential: D.M.D.
Phone: 803-984-0682