Healthcare Provider Details

I. General information

NPI: 1932040540
Provider Name (Legal Business Name): THE DENTAL OFFICE AT FORT MILL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 CROSSROADS PLZ
FORT MILL SC
29708-8017
US

IV. Provider business mailing address

765 CROSSROADS PLZ
FORT MILL SC
29708-8017
US

V. Phone/Fax

Practice location:
  • Phone: 803-396-7833
  • Fax:
Mailing address:
  • Phone: 803-396-7833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SCHUT
Title or Position: OWNER
Credential: DMD
Phone: 910-969-9883