Myles Richard Clancy, D.M.D.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN1857946 Issued in MA

Practice address

209 Harvard St
Brookline, MA 02446-5071

Phone

(617) 731-5437

NPI assigned

May 27, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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.

• 42 North Dental Care, LLC

  • Pediatric Dentistry
  • Brookline, MA
  • NPI 1518554948
  NPD (past)
• Pediatric Dentistry and Orthodontics PLLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • New Britain, CT
  • NPI 1225546567

  Pediatric Dentistry

  NPD (past)

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

{
    "created_epoch": "1464307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536710400000",
    "number": "1922456276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 S PAULINA ST",
            "address_2": "M/C 850, RM 256",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606127210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 HARVARD ST",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024465071",
            "telephone_number": "617-731-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLANCY",
        "first_name": "MYLES",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-27",
        "last_updated": "2018-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MA",
            "license": "DN1857946",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol R. Ciaravino, L..I.C.S.W.
• Stephen K Cina, LIC. AC.
• Citidental Brookline PLLC
• Citidental Center Brookline
• Johanna G Clair
• Kimberly Clark Lucero, SLP
• Charles Whitman Clark, MSSS
• Jennifer Cathryn Clark, OTR/L
• Paul R Clark, ORTHOTIST
• Rachael A Clark, MD PHD

• Pediatric Dentistry in Brookline, MA
• Providers in Brookline, MA by specialty
• Pediatric Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2018; 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.