Patrick T Clancy, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1001596-15 Issued in WI

Practice address

11904 W North Ave Ste 105
Wauwatosa, WI 53226-2062

Phone

(414) 454-0700

NPI assigned

Jun 15, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• MDC West Bend, LLC

  • Dentist
  • West Bend, WI
  • NPI 1497294722
  NPD (past)
• Paradise Dental Professionals S.C.

  • Periodontics
  • West Bend, WI
  • NPI 1649492208
  NPD (past)
• Wauwatosa Family Dental

  • Dental Clinic/Center
  • Wauwatosa, WI
  • NPI 1821580572
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590019200000",
    "number": "1699205336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11904 W NORTH AVE STE 105",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532262062",
            "telephone_number": "608-225-4856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11904 W NORTH AVE STE 105",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532262062",
            "telephone_number": "414-454-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLANCY",
        "first_name": "PATRICK",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-15",
        "last_updated": "2020-05-21",
        "certification_date": "2020-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1001596-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Richard Cieszynski, ATC
• Gina Cifaldi, M.S., R.T.(R)
• City of Wauwatosa
• City of Wauwatosa
• City of Wauwatosa Health Department
• Clara Healing Institute LLC
• Aasiyah Clark, LPC
• Cynthia Ann Clark, LCSW
• Melanie Anne Clark, M.D.
• Julia Clayton

• General Practice Dentistry in Wauwatosa, WI
• Providers in Wauwatosa, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.