MEDICARE: DR. DANIEL J CLANCY 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	10658	MA

General Provider Information

NPI Number	:	1194700260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL J CLANCY DDS

Provider Business Mailing Address
First Line	:	511 W GROVE ST
Second Line	:	#203
City	:	MIDDLEBORO
State	:	MA
Zip	:	02346-1458
Country	:	US
Telephone Number	:	508-947-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	511 W GROVE ST
Second Line	:	#203
City	:	MIDDLEBORO
State	:	MA
Zip	:	02346-1458
Country	:	US
Telephone Number	:	508-947-8000
Fax Number	:

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	07/08/2007

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