Provider Demographics
NPI:1689683658
Name:ANCIRO, DENNIS U (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:U
Last Name:ANCIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42502
Mailing Address - Country:US
Mailing Address - Phone:606-677-6787
Mailing Address - Fax:606-451-0035
Practice Address - Street 1:754 S HWY 27
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501
Practice Address - Country:US
Practice Address - Phone:606-677-6787
Practice Address - Fax:606-451-0035
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36694207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0950708Medicare ID - Type Unspecified
H82724Medicare UPIN