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General NPI Number Information
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NPI Number | 1316207640
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Entity Type | Organization
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Legal Business Name | RENTZ FAMILY DENTISTRY
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 05/21/2012
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Provider Practice Location Address
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Address Line | 775 KINGS BAY RD B
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City | ST. MARYS
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State | GA
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Zip | 31558
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Country | US
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Telephone | 912-510-6000
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Fax | 912-510-6004
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Provider Business Mailing Address
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Address Line | 775 KINGS BAY RD B
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City | ST. MARYS
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State | GA
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Zip | 31558
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Country | US
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Telephone | 912-510-6000
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Fax | 912-510-6004
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Authorized Official
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Title or Position | DENTIST
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Name | MR. STAN L RENTZ
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Credential | DMD
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Telephone | 912-510-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN013769
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License Number State | GA
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