Organization
FLOWER MOUND DENTISTRY DIVINE
Active
Other names
FLower Mound Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIAMESHA MICHALLE MCCLELLAN D.D.S. (PRESIDENT)
(972) 539-4290
Entity
Organization
Contact information
Practice address
2200 MORRISS RD STE 150, FLOWER MOUND, TX 75028-3239
(972) 539-4290
(972) 355-1736
Mailing address
2200 MORRISS RD STE 150, FLOWER MOUND, TX 75028-3239
(972) 539-4290
(972) 355-1736
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
15884
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144438060
INDIVIDUAL PIN NUMBER
TX
Enumeration date
05/24/2007
Last updated
08/22/2020
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