MEDICARE: DR. HARRY NICK BOBOTIS 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
1	1223G0001X	General Practice Dentistry	3490	SC
2	122300000X	Dentist	DN011989	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215981352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARRY NICK BOBOTIS DMD

Provider Business Mailing Address
First Line	:	112 VILSECK ROAD
Second Line	:	BLDG 419-2
City	:	FORT STEWART
State	:	GA
Zip	:	31315
Country	:	US
Telephone Number	:	912-257-7056
Fax Number	:	912-257-7055

Provider Business Practice Location Address
First Line	:	112 VILSECK ROAD
Second Line	:	BLDG 419-2
City	:	FORT STEWART
State	:	GA
Zip	:	31315
Country	:	US
Telephone Number	:	912-257-7056
Fax Number	:	912-257-7055

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	07/21/2022

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