Provider Demographics
NPI:1487676342
Name:RYAN M CLANCY DMD PC
Entity Type:Organization
Organization Name:RYAN M CLANCY DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLANCY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-396-8558
Mailing Address - Street 1:80 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3872
Mailing Address - Country:US
Mailing Address - Phone:781-396-8558
Mailing Address - Fax:781-396-8559
Practice Address - Street 1:80 HIGH ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3872
Practice Address - Country:US
Practice Address - Phone:781-396-8558
Practice Address - Fax:781-396-8559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty