Provider Demographics
NPI:1316207640
Name:RENTZ FAMILY DENTISTRY
Entity Type:Organization
Organization Name:RENTZ FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-510-6000
Mailing Address - Street 1:775 KINGS BAY RD
Mailing Address - Street 2:B
Mailing Address - City:ST. MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558
Mailing Address - Country:US
Mailing Address - Phone:912-510-6000
Mailing Address - Fax:912-510-6004
Practice Address - Street 1:775 KINGS BAY RD
Practice Address - Street 2:B
Practice Address - City:ST. MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558
Practice Address - Country:US
Practice Address - Phone:912-510-6000
Practice Address - Fax:912-510-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013769261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental