Provider Demographics
NPI:1407963853
Name:WILLIAM W CLANCE DMD PC
Entity Type:Organization
Organization Name:WILLIAM W CLANCE DMD PC
Other - Org Name:PROF CORP
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:CLANCE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-685-2100
Mailing Address - Street 1:PO BOX 718
Mailing Address - Street 2:
Mailing Address - City:METTER
Mailing Address - State:GA
Mailing Address - Zip Code:30439
Mailing Address - Country:US
Mailing Address - Phone:912-685-2100
Mailing Address - Fax:912-685-6915
Practice Address - Street 1:500 N LEWIS ST
Practice Address - Street 2:
Practice Address - City:METTER
Practice Address - State:GA
Practice Address - Zip Code:30439
Practice Address - Country:US
Practice Address - Phone:912-685-2100
Practice Address - Fax:912-685-6915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA91491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty