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General NPI Number Information
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NPI Number | 1184290546
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Entity Type | Individual
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Provider Name | DOMINIKA SARA WISNIEWSKA DMD
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Gender | Female
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Dates
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Enumeration Date | 05/27/2021
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Last Update Date | 06/06/2022
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Provider Practice Location Address
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Address Line | 194 ROBERT SMALLS PKWY
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City | BEAUFORT
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State | SC
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Zip | 29906-3202
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Country | US
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Telephone | 843-473-3148
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Fax |
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Provider Business Mailing Address
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Address Line | 128 HADDINGTON LN
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City | GREENVILLE
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State | SC
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Zip | 29609-2328
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Country | US
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Telephone | 864-551-5745
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9897
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License Number State | SC
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