Individual
ADVAITA SUSARLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5621 RIVERS AVE, NORTH CHARLESTON, SC 29406-6022
(843) 641-0143
Mailing address
5621 RIVERS AVE, NORTH CHARLESTON, SC 29406-6022
(843) 641-0143
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
1001729
WI
1223G0001X
General Practice Dentistry
Primary
11068
SC
1223G0001X
General Practice Dentistry
35896
TX
Other
Enumeration date
12/26/2017
Last updated
05/13/2025
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