Provider Demographics
NPI:1164558128
Name:HENTZ, JAMES PAGET (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PAGET
Last Name:HENTZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 WAPPOO RD STE G
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5969
Mailing Address - Country:US
Mailing Address - Phone:843-571-7280
Mailing Address - Fax:843-571-3437
Practice Address - Street 1:925 WAPPOO RD STE G
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5969
Practice Address - Country:US
Practice Address - Phone:843-571-7280
Practice Address - Fax:843-571-3437
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice