NPIMap

Organization Active NPI

Medical University of South Carolina

Doing business as Theresa Sullivan Gonzales DMD Ms MSS

  • Oral and Maxillofacial Pathology Dentistry
  • Charleston, SC
National Provider Identifier
1639593254
Registry record updated Feb 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X
Legal business name
MEDICAL UNIVERSITY OF SOUTH CAROLINA
Doing business as
Theresa Sullivan Gonzales DMD Ms MSS
Practice address
173 Ashley Ave
Charleston, SC 29425-8908
Phone
(843) 792-4496
NPI assigned
Feb 18, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2014

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

Authorized official

Name
Theresa Gonzales, DMD
Title
Director
Phone
(843) 792-4496

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Pathology DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0106X Primary

Addresses

Primary practice location

173 Ashley Ave
Charleston, SC 29425-8908

Mailing address

PO Box 10076
Van Nuys, CA 91410-0076
Phone (805) 578-8300

Other names 1

  • THERESA SULLIVAN GONZALES DMD MS MSS Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1392681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392681600000",
    "number": "1639593254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10076",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914100076",
            "telephone_number": "805-578-8300",
            "fax_number": "805-578-3911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "173 ASHLEY AVE",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294258908",
            "telephone_number": "843-792-4496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL UNIVERSITY OF SOUTH CAROLINA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-18",
        "last_updated": "2014-02-18",
        "status": "A",
        "authorized_official_last_name": "GONZALES",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "843-792-4496",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THERESA SULLIVAN GONZALES DMD MS MSS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.