Provider Demographics
NPI:1083795736
Name:CLANCY, TERENCE G
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:G
Last Name:CLANCY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 LAUREL ST
Mailing Address - Street 2:D
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3900
Mailing Address - Country:US
Mailing Address - Phone:650-508-3040
Mailing Address - Fax:650-593-4850
Practice Address - Street 1:990 LAUREL ST
Practice Address - Street 2:D
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3900
Practice Address - Country:US
Practice Address - Phone:650-508-3040
Practice Address - Fax:650-593-4850
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA353851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice