Advaita Susarla, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11068 Issued in SC

Practice address

5621 Rivers Ave
North Charleston, SC 29406-6022

Phone

(843) 641-0143

NPI assigned

Dec 26, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Familia Dental Mkemitchell LLC

  • Dental Clinic/Center
  • Milwaukee, WI
  • NPI 1609259266

  General Practice

  NPD (past)

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

{
    "created_epoch": "1514246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747094400000",
    "number": "1346756533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5621 RIVERS AVE",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294066022",
            "telephone_number": "843-641-0143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5621 RIVERS AVE",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294066022",
            "telephone_number": "843-641-0143"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "821 S Layton Blvd",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532151225",
            "country_code": "US",
            "telephone_number": "888-988-4066",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUSARLA",
        "first_name": "ADVAITA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-12-26",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "1001729",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "35896",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "11068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel F Sullivan, DO
• John Barnwell Summerlin, RPH
• Summit BHC Cameron, LLC
• Lyndsey Supsie, CCC-SLP
• Ann E Surprenant, MD
• Mary Alison Sutherland, WHNP
• Shad J Sutherland, RPH
• Robert Michael Sutter, PMHNP
• Mary Larson Svendsen, PHD
• Andrew Swanson, DPT

• General Practice Dentistry in North Charleston, SC
• Providers in North Charleston, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.