Provider Demographics
NPI:1629186804
Name:PENSYL, RYAN DANIEL (DMD)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:DANIEL
Last Name:PENSYL
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 1:12600 WINCHESTER RD.
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502
Mailing Address - Country:US
Mailing Address - Phone:301-729-0444
Mailing Address - Fax:301-729-0404
Practice Address - Street 1:12600 WINCHESTER RD.
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502
Practice Address - Country:US
Practice Address - Phone:301-729-0444
Practice Address - Fax:301-729-0404
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0369651223G0001X
MD16067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD110468300Medicaid