Provider Demographics
NPI:1417119470
Name:RENTZ, STAN LAWRENCE (DMD)
Entity Type:Individual
Prefix:DR
First Name:STAN
Middle Name:LAWRENCE
Last Name:RENTZ
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 1:111 E GORDON ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-4554
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41 OLD SCHOOL RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:GA
Practice Address - Zip Code:39854-4627
Practice Address - Country:US
Practice Address - Phone:229-334-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013769122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist