Provider Demographics
NPI:1205497682
Name:MCCLURG, DEVON ELISE (DMD)
Entity type:Individual
Prefix:DR
First Name:DEVON
Middle Name:ELISE
Last Name:MCCLURG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 CROCKETT ST APT 1703
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3293
Mailing Address - Country:US
Mailing Address - Phone:720-345-2343
Mailing Address - Fax:
Practice Address - Street 1:185 NW JOHN JONES DR STE 600
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8043
Practice Address - Country:US
Practice Address - Phone:817-295-8884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX352801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty