Provider Demographics
NPI:1164820593
Name:DAVID F. YENTZ, D.D.S., P.C.
Entity Type:Organization
Organization Name:DAVID F. YENTZ, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:TREECE
Authorized Official - Suffix:
Authorized Official - Credentials:CDA
Authorized Official - Phone:734-242-8885
Mailing Address - Street 1:1080 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-3193
Mailing Address - Country:US
Mailing Address - Phone:734-242-8885
Mailing Address - Fax:734-242-1410
Practice Address - Street 1:1080 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3193
Practice Address - Country:US
Practice Address - Phone:734-242-8885
Practice Address - Fax:734-242-1410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010112081223G0001X
MI29010199341223G0001X
MI29010198931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty