Healthcare Provider Details

I. General information

NPI: 1376884130
Provider Name (Legal Business Name): RACHEL GENTZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 HARVARD ST APT 7
BROOKLINE MA
02446-6476
US

IV. Provider business mailing address

7414 MYRTLE VISTA AVE
SACRAMENTO CA
95831-4048
US

V. Phone/Fax

Practice location:
  • Phone: 734-645-9049
  • Fax:
Mailing address:
  • Phone: 734-645-9049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number107365
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: