MEDICARE: DR. NICHOLAS BAUTZ 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	DGD11123	SC

General Provider Information

NPI Number	:	1861386708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS BAUTZ DMD

Provider Business Mailing Address
First Line	:	1677 SAVANNAH HWY
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-6256
Country	:	US
Telephone Number	:	843-371-5108
Fax Number	:

Provider Business Practice Location Address
First Line	:	1677 SAVANNAH HWY
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-6256
Country	:	US
Telephone Number	:	843-371-5108
Fax Number	:

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

Provider Enumeration Date	:	06/05/2025
Last Update Date	:	05/06/2026

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