Provider Demographics
NPI:1730735622
Name:MCCLURE, KYLEE (DMD)
Entity type:Individual
Prefix:DR
First Name:KYLEE
Middle Name:
Last Name:MCCLURE
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 1:7722 ENCHANTED RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-7515
Mailing Address - Country:US
Mailing Address - Phone:623-312-6320
Mailing Address - Fax:
Practice Address - Street 1:2954 CARRINGTON RD
Practice Address - Street 2:DENTAL CLINIC #3
Practice Address - City:FORT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79916
Practice Address - Country:US
Practice Address - Phone:915-742-3303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDB-2024-0298122300000X
AZD010362122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist