Provider Demographics
NPI:1255570156
Name:DANIEL J. CLANCY D.D.S. P.C.
Entity type:Organization
Organization Name:DANIEL J. CLANCY D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLANCY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-947-8000
Mailing Address - Street 1:511 W GROVE ST
Mailing Address - Street 2:203
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-1458
Mailing Address - Country:US
Mailing Address - Phone:508-947-8000
Mailing Address - Fax:
Practice Address - Street 1:511 W GROVE ST
Practice Address - Street 2:203
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1458
Practice Address - Country:US
Practice Address - Phone:508-947-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106581223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9796126Medicaid