MEDICARE: THE DENTAL OFFICE AT FORT MILL

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

General Provider Information

NPI Number	:	1932040540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DENTAL OFFICE AT FORT MILL

Provider Business Mailing Address
First Line	:	765 CROSSROADS PLZ
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-8017
Country	:	US
Telephone Number	:	803-396-7833
Fax Number	:

Provider Business Practice Location Address
First Line	:	765 CROSSROADS PLZ
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-8017
Country	:	US
Telephone Number	:	803-396-7833
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL SCHUT
Credential	:	DMD
Telephone Number	:	910-969-9883

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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