Provider Demographics
NPI:1184290546
Name:WISNIEWSKA, DOMINIKA SARA (DMD)
Entity type:Individual
Prefix:DR
First Name:DOMINIKA
Middle Name:SARA
Last Name:WISNIEWSKA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 HADDINGTON LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-2328
Mailing Address - Country:US
Mailing Address - Phone:864-551-5745
Mailing Address - Fax:
Practice Address - Street 1:194 ROBERT SMALLS PKWY
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-3202
Practice Address - Country:US
Practice Address - Phone:843-473-3148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC98971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice