Kiamesha Michalle McClellan, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

15884 Issued in TX

Practice address

2200 Morriss Rd Ste 150
Flower Mound, TX 75028-3239

Phone

(972) 539-4290

Fax

(975) 355-1736

NPI assigned

May 21, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Flower Mound Dentistry Divine

  • Dental Clinic/Center
  • Flower Mound, TX
  • NPI 1235340365
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144438060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 MORRISS RD STE 150",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750283239",
            "telephone_number": "972-539-4290",
            "fax_number": "975-355-1736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 MORRISS RD STE 150",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750283239",
            "telephone_number": "972-539-4290",
            "fax_number": "975-355-1736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLELLAN",
        "first_name": "KIAMESHA",
        "middle_name": "MICHALLE",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "15884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Akiko Jeanette McCann
• Sherri Lynn McCarthy, L.P.C.-S.
• Mandy Natasha McCarver, LSA
• Julianne McClain, LCSW
• Bradley D. McClatchey, P.T.
• Ashleigh McClendon, D.O.
• Sarina Janay McClinton, PT, DPT
• John Keegan McConnell, PT
• Kristen J. McConnell, PT
• Tiffany McCoy Moore, DC

• General Practice Dentistry in Flower Mound, TX
• Providers in Flower Mound, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.