Provider Demographics
NPI:1053492033
Name:MCLEROY, JOHN DONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DONALD
Last Name:MCLEROY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 CARTER CREEK PARKWAY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-4455
Mailing Address - Country:US
Mailing Address - Phone:979-846-2098
Mailing Address - Fax:
Practice Address - Street 1:4343 CARTER CREEK PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4491
Practice Address - Country:US
Practice Address - Phone:979-846-2098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice