Healthcare Provider Details

I. General information

NPI: 1629186804
Provider Name (Legal Business Name): RYAN DANIEL PENSYL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 WINCHESTER RD.
CUMBERLAND MD
21502
US

IV. Provider business mailing address

12600 WINCHESTER RD.
CUMBERLAND MD
21502
US

V. Phone/Fax

Practice location:
  • Phone: 301-729-0444
  • Fax: 301-729-0404
Mailing address:
  • Phone: 301-729-0444
  • Fax: 301-729-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number16067
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS036965
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: