Provider Demographics
NPI:1649498627
Name:MCCLURE, STEPHEN KEES (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:KEES
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ARONA RD
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-3100
Mailing Address - Country:US
Mailing Address - Phone:724-864-9024
Mailing Address - Fax:
Practice Address - Street 1:300 ARONA RD
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-3100
Practice Address - Country:US
Practice Address - Phone:724-864-9024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019597L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA126785Medicaid
PA126785Medicaid