Provider Demographics
NPI:1639430010
Name:MCCLAIN, ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14227 E HIGHWAY 40
Mailing Address - Street 2:HAWTHORNE SQUARE
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64136-1187
Mailing Address - Country:US
Mailing Address - Phone:816-478-0013
Mailing Address - Fax:
Practice Address - Street 1:14227 E HIGHWAY 40
Practice Address - Street 2:HAWTHORNE SQUARE
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64136-1187
Practice Address - Country:US
Practice Address - Phone:816-478-0013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012016508122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist