Provider Demographics
NPI:1457639866
Name:RENTZ, DEVIN KORY
Entity Type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:KORY
Last Name:RENTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17021 LINCOLN AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3146
Mailing Address - Country:US
Mailing Address - Phone:720-851-7069
Mailing Address - Fax:720-842-1024
Practice Address - Street 1:17021 LINCOLN AVE UNIT B
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3146
Practice Address - Country:US
Practice Address - Phone:720-851-7069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2019091223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice