Provider Demographics
NPI:1376884130
Name:GENTZ, RACHEL (DMD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:GENTZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7414 MYRTLE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-4048
Mailing Address - Country:US
Mailing Address - Phone:734-645-9049
Mailing Address - Fax:
Practice Address - Street 1:154 HARVARD ST
Practice Address - Street 2:APT 7
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6476
Practice Address - Country:US
Practice Address - Phone:734-645-9049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1073651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program