Provider Demographics
NPI:1245379213
Name:CLANCE, WILLIAM WESLEY JR
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WESLEY
Last Name:CLANCE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:CLANCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 718
Mailing Address - Street 2:
Mailing Address - City:METTER
Mailing Address - State:GA
Mailing Address - Zip Code:30439-0718
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:30439-3757
Practice Address - Country:US
Practice Address - Phone:912-685-2100
Practice Address - Fax:912-685-6915
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA91491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGA9149OtherSTATE LICENSE NUMBER