Provider Demographics
NPI:1346284445
Name:MCCLURE, TONY W (DDS)
Entity type:Individual
Prefix:DR
First Name:TONY
Middle Name:W
Last Name:MCCLURE
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 1:11662 GRAVOIS RD UNIT 8504
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-4029
Mailing Address - Country:US
Mailing Address - Phone:314-717-1411
Mailing Address - Fax:
Practice Address - Street 1:3320 RUTGER ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1122
Practice Address - Country:US
Practice Address - Phone:314-977-8363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1287351223P0221X
MO20110124901223P0221X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9179989Medicaid