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NPI Code Detail

MEDICARE: DR. KEVIN D. MCCLURE DDS

MEDICARE: DR. KEVIN D. MCCLURE DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry019-025535IL

General Provider Information

NPI Number : 1356322929
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEVIN D. MCCLURE DDS
Provider Business Mailing Address
First Line : 7301 W 25TH ST
Second Line : #127
City : NORTH RIVERSIDE
State : IL
Zip : 60546-1409
Country : US
Telephone Number : 708-732-1997
Fax Number :
Provider Business Practice Location Address
First Line : 7301 W 25TH ST
Second Line : #127
City : NORTH RIVERSIDE
State : IL
Zip : 60546-1409
Country : US
Telephone Number : 708-732-1997
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2005
Last Update Date : 09/20/2009

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