Provider Demographics
NPI:1114557501
Name:CASEY, CLANCY ANN (RDH, BS, LAP)
Entity Type:Individual
Prefix:
First Name:CLANCY
Middle Name:ANN
Last Name:CASEY
Suffix:
Gender:F
Credentials:RDH, BS, LAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3774 JOELLE DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-6102
Mailing Address - Country:US
Mailing Address - Phone:406-431-8854
Mailing Address - Fax:
Practice Address - Street 1:3774 JOELLE DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-6102
Practice Address - Country:US
Practice Address - Phone:406-431-8854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1068124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist