Provider Demographics
NPI:1073022562
Name:RYAN D PENSYL, DMD, PA
Entity Type:Organization
Organization Name:RYAN D PENSYL, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/DENTAL HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEAVNER
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:301-729-0444
Mailing Address - Street 1:12600 WINCHESTER RD SW
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6551
Mailing Address - Country:US
Mailing Address - Phone:301-729-0444
Mailing Address - Fax:301-729-0404
Practice Address - Street 1:12600 WINCHESTER RD SW
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6551
Practice Address - Country:US
Practice Address - Phone:301-729-0444
Practice Address - Fax:301-729-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD160671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty