Provider Demographics
NPI:1205067360
Name:MANKIEWICZ, RYAN S (DDS)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:S
Last Name:MANKIEWICZ
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 1:730 HOWARDS LOOP
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-8740
Mailing Address - Country:US
Mailing Address - Phone:410-533-8010
Mailing Address - Fax:
Practice Address - Street 1:8055 RITCHIE HWY STE 102
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-1074
Practice Address - Country:US
Practice Address - Phone:410-590-6690
Practice Address - Fax:410-590-1693
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD145991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice