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General NPI Number Information
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NPI Number | 1609207554
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Entity Type | Organization
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Legal Business Name | MARK F. YAMPOLSKY, DDS, MS DBA CAROLINA PERIODONTICS
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Dates
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Enumeration Date | 12/03/2013
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Last Update Date | 12/03/2013
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Provider Practice Location Address
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Address Line | 1064 GARDNER RD SUITE #110
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City | CHARLESTON
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State | SC
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Zip | 29407-5768
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Country | US
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Telephone | 843-556-8778
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Fax | 843-556-7003
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Provider Business Mailing Address
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Address Line | 1064 GARDNER RD SUITE #110
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City | CHARLESTON
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State | SC
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Zip | 29407-5768
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Country | US
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Telephone | 843-556-8778
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Fax | 843-556-7003
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Authorized Official
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Title or Position | OWNER
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Name | MARK F YAMPOLSKY
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Credential |
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Telephone | 843-556-8778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 6934
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 2962
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License Number State | SC
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