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General NPI Number Information
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NPI Number | 1871857169
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Entity Type | Organization
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Legal Business Name | MCCLURE PEDIATRIC DENTISTRY, PLLC
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Dates
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Enumeration Date | 07/01/2012
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Last Update Date | 01/26/2017
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Provider Practice Location Address
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Address Line | 14660 STATE HIGHWAY 121 #300
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City | FRISCO
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State | TX
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Zip | 75035-4629
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Country | US
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Telephone | 972-549-4036
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Fax |
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Provider Business Mailing Address
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Address Line | 14660 STATE HIGHWAY 121 #300
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City | FRISCO
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State | TX
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Zip | 75035
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Country | US
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Telephone | 972-549-4036
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JON WESLEY MCCLURE
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Credential | D.D.S.
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Telephone | 972-549-4036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 23879
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License Number State | TX
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