Healthcare Provider Details

I. General information

NPI: 1316207640
Provider Name (Legal Business Name): RENTZ FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 KINGS BAY RD B
ST. MARYS GA
31558
US

IV. Provider business mailing address

775 KINGS BAY RD B
ST. MARYS GA
31558
US

V. Phone/Fax

Practice location:
  • Phone: 912-510-6000
  • Fax: 912-510-6004
Mailing address:
  • Phone: 912-510-6000
  • Fax: 912-510-6004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDN013769
License Number StateGA

VIII. Authorized Official

Name: MR. STAN L RENTZ
Title or Position: DENTIST
Credential: DMD
Phone: 912-510-6000