Provider Demographics
NPI:1871857169
Name:MCCLURE PEDIATRIC DENTISTRY, PLLC
Entity Type:Organization
Organization Name:MCCLURE PEDIATRIC DENTISTRY, PLLC
Other - Org Name:MCCLURE PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-549-4036
Mailing Address - Street 1:14660 STATE HIGHWAY 121
Mailing Address - Street 2:#300
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035
Mailing Address - Country:US
Mailing Address - Phone:972-549-4036
Mailing Address - Fax:
Practice Address - Street 1:14660 STATE HIGHWAY 121
Practice Address - Street 2:#300
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-4629
Practice Address - Country:US
Practice Address - Phone:972-549-4036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-01
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23879261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental