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NPI Code Detail

MEDICARE: DR. CHARLES DANIEL MCNUTT II DMD

MEDICARE: DR. CHARLES DANIEL MCNUTT II DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry3334SC

General Provider Information

NPI Number : 1386734176
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES DANIEL MCNUTT II DMD
Provider Business Mailing Address
First Line : 975 N CHURCH ST
Second Line :
City : SPARTANBURG
State : SC
Zip : 29303-4104
Country : US
Telephone Number : 864-582-4308
Fax Number : 864-596-4492
Provider Business Practice Location Address
First Line : 5711 RIVERS AVE
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-6028
Country : US
Telephone Number : 803-744-8338
Fax Number : 803-744-9374
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 07/08/2007

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