Provider Demographics
NPI:1194700260
Name:CLANCY, DANIEL J (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:CLANCY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106581223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery