Individual
DR. THERESA SULLIVAN GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD, MS
Contact information
Practice address
173 ASHLEY AVENUE MSC 507, CHARLESTON, SC 29401
(843) 792-8723
(843) 792-3697
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
17566
TX
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
2648
SC
Other
Enumeration date
04/06/2006
Last updated
08/31/2016
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