Basic Information
| Provider Information | |||||||||
| NPI: | 1689683658 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANCIRO | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | U | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 997 | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066776787 | ||||||||
| FaxNumber: | 6064510035 | ||||||||
| Practice Location | |||||||||
| Address1: | 754 S HWY 27 | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066776787 | ||||||||
| FaxNumber: | 6064510035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 12/05/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 36694 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QA0401X | 36694 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine |
No ID Information.