MEDICAL UNIVERSITY OF SOUTH CAROLINA (NPI# 1639593254) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639593254 |
| Entity Type | Organization |
| Organization Name | MEDICAL UNIVERSITY OF SOUTH CAROLINA |
| Other Organization Name | THERESA SULLIVAN GONZALES DMD MS MSS |
| Practice Address |
173 Ashley Ave Charleston SC 29425-8908 |
| Mailing Address |
Po Box 10076 Van Nuys CA 91410-0076 |
| Practice Telephone | 8437924496 |
| Mailing Telephone | 8055788300 |
| Mailing Fax Number | 8055783911 |
| Enumeration Date | 2014-02-18 |
| Last Update Date | 2014-02-18 |
| Authorized Official Name | THERESA GONZALES (DIRECTOR) |
| Authorized Official Telephone | 8437924496 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0106X |
Dentist Specialization: Oral and Maxillofacial Pathology |
Dental Providers |
| Other Name | Type Code |
|---|---|
| THERESA SULLIVAN GONZALES DMD MS MSS | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669950903 | Medical University of South Carolina | Clinic/Center | 30 Bee St Ste 102, Charleston, SC 29425-8910 | 2018-07-30 |
| 1295161420 | Medical University of South Carolina | General Acute Care Hospital | 8792 Shadowglen Dr, North Charleston, SC 29420-8358 | 2013-09-19 |
| 1407053853 | Medical University of South Carolina | General Acute Care Hospital | 167 Ashley Avenue, Suite 301, Charleston, SC 29425 | 2007-06-29 |
| 1053422790 | Medical University of South Carolina | Clinic/Center | 60 Barre St, Charleston, SC 29401-1106 | 2006-08-31 |
| 1437636057 | Medical University of South Carolina | Clinical Medical Laboratory | 171 Ashley Ave, Charleston, SC 29425-0100 | 2018-07-26 |
| 1538452313 | Medical University of South Carolina | General Acute Care Hospital | 171 Ashley Ave, Charleston, SC 29425-0100 | 2011-05-26 |
| 1275840423 | Medical University of South Carolina | Clinic/Center | 25 Courtenay Dr, Charleston, SC 29425-8911 | 2010-09-09 |
| 1285818104 | Medical University of South Carolina | General Acute Care Hospital | 169 Ashley Ave, Charleston, SC 29425-8905 | 2007-12-27 |
| 1659560670 | Medical University of South Carolina | Clinic/Center | 2125 Charlie Hall Blvd, Charleston, SC 29414-5879 | 2007-10-16 |
| 1508052283 | Medical University of South Carolina | General Acute Care Hospital | 135 Rutledge St, Charleston, SC 29425-8903 | 2007-09-17 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MEDICAL UNIVERSITY OF SOUTH CAROLINA THE | 179 Ashley Ave, Charleston, SC 29425-8908 |
| Street Address |
173 ASHLEY AVE |
| City | CHARLESTON |
| State | SC |
| Zip Code | 29425-8908 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053303966 | Mullen O Coover | Dentist | 173 Ashley Ave, Bsb-335, Charleston, SC 29425-8908 | 2005-08-17 |
| 1093331472 | Austin Anthony Hughes | Dentist | 173 Ashley Ave, Charleston, SC 29425-8908 | 2020-06-22 |
| 1205489739 | Frances Gouldin | Dentist | 173 Ashley Ave, Charleston, SC 29425-8908 | 2019-07-23 |
| 1093105579 | Timothy Rohde | Dentist | 173 Ashley Ave, Bsb 546, Msc 507, Charleston, SC 29425-8908 | 2015-02-04 |
| 1194026153 | Medical University of Sc | Dentist | 173 Ashley Ave, Charleston, SC 29425-8908 | 2010-11-08 |
| 1780902734 | Jompobe Vuthiganon | Dentist | 173 Ashley Ave, Bsb Rm 546, Charleston, SC 29425-8908 | 2010-05-13 |
| 1558595074 | Mark Lane Mcentire | Dentist | 173 Ashley Ave, Charleston, SC 29425-8908 | 2009-05-12 |
| 1902069271 | Michael Kinon Lecholop | Dentist | 173 Ashley Ave, Charleston, SC 29425-8908 | 2008-07-08 |
| 1174708010 | Frederick Thomas Moore | Dentist | 173 Ashley Ave, Bsb 249, Charleston, SC 29425-8908 | 2008-01-09 |
| 1952517161 | Musc College of Dental Medicine | Clinic/Center | 173 Ashley Ave, Bsb 246, Charleston, SC 29425-0001 | 2007-05-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922607217 | Krishna Bhandari | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 10 Mcclennan Banks Drive, 2190-r, Msc 918, Charleston, SC 29425 | 2020-10-19 |
| 1649892456 | Mary Macrae Lynch | Social Worker | 179 Ashley Avenue, Charleston, SC 29425 | 2020-05-14 |
| 1528600053 | Amanda Watts | Physician Assistant | 135 Rutledge Ave. Msc 561, Charleston, SC 29425 | 2019-10-16 |
| 1851945497 | Kacy Wonder | Dentist | 173 Ashley Avenue Room 453 Msc 507, Charleston, SC 29425 | 2019-08-01 |
| 1477114569 | Justin Robert Silverman | Surgery | 169 Ashley Avenue, Room 202 Muh, Msc 333, Charleston, SC 29425 | 2019-06-28 |
| 1740840024 | Tyler Buckley | Surgery | 169 Ashley Ave, Room 202 Main Hospital, Msc333, Charleston, SC 29425 | 2019-06-18 |
| 1366001760 | Rayphael Sebastian Hardy | Internal Medicine | 169 Ashley Avenue Room 202 Main Hospital Msc333, Charleston, SC 29425 | 2019-06-10 |
| 1437718889 | Samar Medani | Internal Medicine | Division of Nephrology, Medical Univ of South Carolina, 96 Jonathan Lucas Street, Room 822, Msc 629, Charleston, SC 29425 | 2019-06-10 |
| 1427617950 | Emily Suzanne Nyers | Internal Medicine | 169 Ashley Ave., Room 202 Main Hospital, Msc 333, Charleston, SC 29425 | 2019-06-09 |
| 1790343564 | Alan Cowei Peh | Psychiatry & Neurology | 169 Ashley Avenue Rm 202, Main Hospital Msc 333, Charleston, SC 29425 | 2019-06-05 |
| Find all providers in zip 29425 | ||||
| Taxonomy Code | 1223P0106X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Pathology |
| The specialty of dentistry and discipline of pathology that deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes, and effects of these diseases. The practice of oral and maxillofacial pathology includes research and diagnosis of diseases using clinical, radiographic, microscopic, biochemical, or other examinations. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912969502 | Theresa Sullivan Gonzales | Dentist | 173 Ashley Avenue Msc 507, Charleston, SC 29401 | 2006-04-06 |
| 1194026153 | Medical University of Sc | Dentist | 173 Ashley Ave, Charleston, SC 29425-8908 | 2010-11-08 |
| 1396904405 | Christel Maria Haberland | Dentist | 171 Ashley Ave, Charleston, SC 29425-4804 | 2008-06-03 |
| 1275614828 | Brad Wesley Neville | Dentist | 173 Ashley Ave, Room 544 Bsb, Division of Oral Pathology, Musc, Charleston, SC 29425-5070 | 2006-10-18 |
| 1255304606 | Angela C Chi | Dentist | 173 Ashley Ave, Musc College of Dental Medicine, Charleston, SC 29425-0001 | 2006-02-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407067473 | Northeast Oral & Maxillofacial | Dentist | 1118 Greenlawn Dr, Columbia, SC 29209-2606 | 2007-05-24 |
| 1174656540 | River Falls Oral Surgery | Dentist | 700 Squires Pt, Duncan, SC 29334-8879 | 2007-03-14 |
| 1871606830 | Jonathan M Lafond | Dentist | 455 Old Trolley Rd, Ste E, Summerville, SC 29485-5669 | 2006-08-16 |
| 1982622585 | Derek T Dunlap | Dentist | 700 Squire's Pointe Drive, Suite A, Duncan, SC 29334 | 2006-07-18 |
| 1831156777 | Larry Wayne Cobb | Dentist | 2c Cleveland Ct, Greenville, SC 29607-2414 | 2006-04-26 |
| 1891774162 | Thomas Herbert Simpson Jr. | Dentist | 372 S Herlong Ave, Rock Hill, SC 29732 | 2006-01-13 |
| 1518177807 | Orangeburg Oral Surgery & Implant Center | Dentist | 1175 Cook Rd, Ste 135, Orangeburg, SC 29118-8201 | 2007-05-23 |
| 1619008547 | Greenville Oral Surgery, P.a. | Dentist | 3929 S Highway 14, Greenville, SC 29615-6138 | 2007-03-09 |
| 1700916822 | Northeast Oral & Maxillofacial Surgery Center | Dentist | 9310 Two Notch Rd, Columbia, SC 29223-6416 | 2007-03-07 |
| 1801976162 | Kenneth M. Burtner | Dentist | 105 Ben Casey Dr, Suite 115, Fort Mill, SC 29708-8561 | 2006-10-17 |
| Find all providers with the same taxonomy | ||||
| City | CHARLESTON |
| Zip Code | 29425 |
Please comment or provide details below to improve the information on MEDICAL UNIVERSITY OF SOUTH CAROLINA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.