Victory Dentistry for Kids

Primary specialty

Point of ServiceTaxonomy code 305S00000X

License

4382 Issued in SC

Legal business name

VICTORY DENTISTRY FOR KIDS

Practice address

9787 Charlotte Hwy Ste 203
Indian Land, SC 29707-5511

Phone

(803) 547-2280

NPI assigned

Apr 7, 2015

Last updated

Apr 7, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tashia McDonald

Title

Manager

Phone

(803) 228-0525

Specialties & licenses 1

Addresses

Other names 1

• Victory Pediatric Dentistry Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1428364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428364800000",
    "number": "1386030351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9787 CHARLOTTE HWY STE 203",
            "city": "INDIAN LAND",
            "state": "SC",
            "postal_code": "297075511",
            "telephone_number": "803-547-2280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9787 CHARLOTTE HWY STE 203",
            "city": "INDIAN LAND",
            "state": "SC",
            "postal_code": "297075511",
            "telephone_number": "803-547-2280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY DENTISTRY FOR KIDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-07",
        "last_updated": "2015-04-07",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "TASHIA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "803-228-0525"
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "SC",
            "license": "4382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Victory Pediatric Dentistry",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Ryan Valencic, D.C.
• Valerie L. Yaniszewski, DMD, PC (Smiles in the Sun)
• Emma Ventura
• Victory Dental Center
• Victory Dental Center, LLC
• Seth Patrick Vining, MD
• Lindsay Collins Waddell, PA-C
• Wal-Mart Stores East LP (Walmart Pharmacy 10-4237)
• Wal-Mart Stores East LP (Vision Center 30-4237)
• Walgreen Co (Walgreens #11564)

• Point of Service in Indian Land, SC
• Providers in Indian Land, SC by specialty
• Point of Service in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.