Provider Demographics
NPI:1174751507
Name:PAUL W. CLANCY, D.D.S., P.C.
Entity type:Organization
Organization Name:PAUL W. CLANCY, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:W
Authorized Official - Last Name:CLANCY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-349-3660
Mailing Address - Street 1:41620 6 MILE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-8528
Mailing Address - Country:US
Mailing Address - Phone:248-349-3660
Mailing Address - Fax:248-349-4698
Practice Address - Street 1:41620 6 MILE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-8528
Practice Address - Country:US
Practice Address - Phone:248-349-3660
Practice Address - Fax:248-349-4698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010113771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty