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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