Provider Demographics
NPI:1104089838
Name:PENTZER, JOHN CHARLES (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:PENTZER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 MAIN STREET
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136
Mailing Address - Country:US
Mailing Address - Phone:410-833-8330
Mailing Address - Fax:410-833-8330
Practice Address - Street 1:316 MAIN STREET
Practice Address - Street 2:SUITE 1-C
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136
Practice Address - Country:US
Practice Address - Phone:410-833-8330
Practice Address - Fax:410-833-8330
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3808122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist