Provider Demographics
NPI:1497753339
Name:MCCLUER, CHARLES FORRER ANDERSON III (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FORRER ANDERSON
Last Name:MCCLUER
Suffix:III
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 1:3600 HULEN ST
Mailing Address - Street 2:BLDG. A1
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6863
Mailing Address - Country:US
Mailing Address - Phone:817-731-2661
Mailing Address - Fax:817-731-2665
Practice Address - Street 1:3600 HULEN ST
Practice Address - Street 2:BLDG. A1
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6863
Practice Address - Country:US
Practice Address - Phone:817-731-2661
Practice Address - Fax:817-731-2665
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12214122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist