MEDICARE: DANIEL D. MCCLENAHAN D.D.S. P.C.

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	:	1427046416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL D. MCCLENAHAN D.D.S. P.C.

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

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

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL D MCCLENAHAN
Credential	:	D.D.S.
Telephone Number	:	308-987-2437

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	06/23/2008

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