Healthcare Provider Details

I. General information

NPI: 1265836423
Provider Name (Legal Business Name): RYAN CAPITAN ROTHER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 EDGEWOOD RD
YORK PA
17402-4325
US

IV. Provider business mailing address

845 EDGEWOOD RD
YORK PA
17402-4325
US

V. Phone/Fax

Practice location:
  • Phone: 717-757-3474
  • Fax:
Mailing address:
  • Phone: 717-757-3474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS039951
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: