Provider Demographics
NPI:1447462080
Name:MCCLAY, JON KEVIN (DDS)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:KEVIN
Last Name:MCCLAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2258
Mailing Address - Country:US
Mailing Address - Phone:816-524-3734
Mailing Address - Fax:816-524-9211
Practice Address - Street 1:517 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2258
Practice Address - Country:US
Practice Address - Phone:816-524-3734
Practice Address - Fax:816-524-9211
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0159641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice