Provider Demographics
NPI:1134321870
Name:RENTZ, HAROLD EDWARD JR (DMD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:EDWARD
Last Name:RENTZ
Suffix:JR
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 1:88 BAY ST
Mailing Address - Street 2:P.O. BOX 526
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-0352
Mailing Address - Country:US
Mailing Address - Phone:912-367-9475
Mailing Address - Fax:912-367-9347
Practice Address - Street 1:88 BAY ST
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0352
Practice Address - Country:US
Practice Address - Phone:912-367-9475
Practice Address - Fax:912-367-9347
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011188122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist