Individual
NICHOLAS BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4500 8TH DIVISION RD, COLUMBIA, SC 29207-5700
(803) 751-2160
Mailing address
4500 8TH DIVISION RD, COLUMBIA, SC 29207-5700
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11318
SC
Other
Enumeration date
07/07/2023
Last updated
01/11/2026
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