Provider Demographics
NPI:1023038049
Name:YANISZEWSKI, VALERIE L (DMD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:L
Last Name:YANISZEWSKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:VALERIE
Other - Middle Name:L
Other - Last Name:OPALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:855 HARVEST POINTE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-7707
Mailing Address - Country:US
Mailing Address - Phone:803-984-0682
Mailing Address - Fax:803-547-6777
Practice Address - Street 1:6237 CAROLINA COMMONS DR
Practice Address - Street 2:SUITE 301
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-6014
Practice Address - Country:US
Practice Address - Phone:803-547-9786
Practice Address - Fax:803-547-6777
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3983Medicaid
SC3983OtherDENTAL LICENSE
SCBO85116699OtherDEA