Healthcare Provider Details

I. General information

NPI: 1003977224
Provider Name (Legal Business Name): EDWARD PAUL RENTSCHLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 ROXBURY ROAD
ROCKFORD IL
61107
US

IV. Provider business mailing address

449 ROXBURY ROAD
ROCKFORD IL
61107
US

V. Phone/Fax

Practice location:
  • Phone: 815-226-4700
  • Fax: 815-391-5188
Mailing address:
  • Phone: 815-226-4700
  • Fax: 815-391-5188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number019020034
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: