MEDICARE: DANIEL D MCCLENAHAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4758	NE

General Provider Information

NPI Number	:	1821086885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL D MCCLENAHAN DDS

Provider Business Mailing Address
First Line	:	PO BOX 264
Second Line	:
City	:	OVERTON
State	:	NE
Zip	:	68863-0264
Country	:	US
Telephone Number	:	308-987-2437
Fax Number	:	308-987-2342

Provider Business Practice Location Address
First Line	:	401 5TH STREET
Second Line	:
City	:	OVERTON
State	:	NE
Zip	:	68863-0264
Country	:	US
Telephone Number	:	308-987-2437
Fax Number	:	308-987-2342

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	07/08/2007

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