Individual provider Active NPI

Harold Edward Rentz Jr., DMD

  • Dentist
  • Baxley, GA
National Provider Identifier
1134321870
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
011188 Issued in GA
Practice address
88 Bay St
Baxley, GA 31513-0352
Phone
(912) 367-9475
Fax
(912) 367-9347
NPI assigned
Jun 4, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 011188 GA Primary

Addresses

Primary practice location

88 Bay St
Baxley, GA 31513-0352

Mailing address

88 Bay St
P.O. Box 526
Baxley, GA 31513-0352
Phone (912) 367-9475

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160809002250 GA Order and Referring Only - DentistPractitioner - Dentist 3476847757

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
011188GAMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1134321870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "88 BAY ST",
            "address_2": "P.O. BOX 526",
            "city": "BAXLEY",
            "state": "GA",
            "postal_code": "315130352",
            "telephone_number": "912-367-9475",
            "fax_number": "912-367-9347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88 BAY ST",
            "city": "BAXLEY",
            "state": "GA",
            "postal_code": "315130352",
            "telephone_number": "912-367-9475",
            "fax_number": "912-367-9347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENTZ",
        "first_name": "HAROLD",
        "middle_name": "EDWARD",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "011188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baxley, GA

Sources for this page

Verify at the official NPI Registry.