Healthcare Provider Details

I. General information

NPI: 1861386708
Provider Name (Legal Business Name): NICHOLAS BAUTZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1677 SAVANNAH HWY
CHARLESTON SC
29407-6256
US

IV. Provider business mailing address

1677 SAVANNAH HWY
CHARLESTON SC
29407-6256
US

V. Phone/Fax

Practice location:
  • Phone: 843-371-5108
  • Fax:
Mailing address:
  • Phone: 843-371-5108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDGD11123
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: