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Organization
MEDICAL UNIVERSITY OF SOUTH CAROLINA
Active
Organization
MEDICAL UNIVERSITY OF SOUTH CAROLINA
Active
Other names
THERESA SULLIVAN GONZALES DMD MS MSS
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA GONZALES DMD (DIRECTOR)
(843) 792-4496
Entity
Organization
Contact information
Practice address
173 ASHLEY AVE, CHARLESTON, SC 29425-8908
(843) 792-4496
Mailing address
PO BOX 10076, VAN NUYS, CA 91410-0076
(805) 578-8300
(805) 578-3911
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
—
—
Other
Enumeration date
02/18/2014
Last updated
02/18/2014
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