Provider Demographics
NPI:1356322929
Name:MCCLURE, KEVIN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:D
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 1:7301 W 25TH ST
Mailing Address - Street 2:#127
Mailing Address - City:NORTH RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1409
Mailing Address - Country:US
Mailing Address - Phone:708-732-1997
Mailing Address - Fax:
Practice Address - Street 1:7301 W 25TH ST
Practice Address - Street 2:#127
Practice Address - City:NORTH RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1409
Practice Address - Country:US
Practice Address - Phone:708-732-1997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2009-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0255351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice