Provider Demographics
NPI:1396862025
Name:CLANCY, ANNE MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNE MARIE
Middle Name:
Last Name:CLANCY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 AND A HALF FORRESTER ST
Mailing Address - Street 2:PROFESSIONAL BUILDING
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950
Mailing Address - Country:US
Mailing Address - Phone:978-462-9611
Mailing Address - Fax:978-463-1751
Practice Address - Street 1:37 AND A HALF FORRESTER ST
Practice Address - Street 2:PROFESSIONAL BUILDING
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950
Practice Address - Country:US
Practice Address - Phone:978-462-9611
Practice Address - Fax:978-463-1751
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice