Provider Demographics
NPI:1801903067
Name:GENTZLER, RICHARD HENRY III (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HENRY
Last Name:GENTZLER
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 BABB DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2506
Mailing Address - Country:US
Mailing Address - Phone:615-443-3633
Mailing Address - Fax:
Practice Address - Street 1:106 BABB DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2506
Practice Address - Country:US
Practice Address - Phone:615-443-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN78821223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440700Medicaid