Provider Demographics
NPI:1942488473
Name:HENSPETTER, RYAN A (DMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:A
Last Name:HENSPETTER
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 1:669 CRESPI DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-3486
Mailing Address - Country:US
Mailing Address - Phone:650-359-1646
Mailing Address - Fax:650-355-8735
Practice Address - Street 1:669 CRESPI DR
Practice Address - Street 2:SUITE F
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-3486
Practice Address - Country:US
Practice Address - Phone:650-359-1646
Practice Address - Fax:650-355-8735
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48287122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist