Provider Demographics
NPI:1881580330
Name:SHAROSSI, SUSANNA YVONNE (DDS)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:YVONNE
Last Name:SHAROSSI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SUSANNA
Other - Middle Name:YVONNE
Other - Last Name:SHARPLES-GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:139 ASHEWOOD LAKE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-2725
Mailing Address - Country:US
Mailing Address - Phone:317-727-1062
Mailing Address - Fax:
Practice Address - Street 1:4500 8TH DIVISION RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29207-5700
Practice Address - Country:US
Practice Address - Phone:803-751-5688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014760A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice