Provider Demographics
NPI:1962425595
Name:FRANTZ, JOHN S (DMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:FRANTZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 MARS HILL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-4800
Mailing Address - Country:US
Mailing Address - Phone:706-769-1945
Mailing Address - Fax:706-769-1928
Practice Address - Street 1:1120 MARS HILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4800
Practice Address - Country:US
Practice Address - Phone:706-769-1945
Practice Address - Fax:706-769-1928
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011132122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00631254AMedicaid