DR. KELLI C. MACK D.D.S.
NPI 1679515696
Dentist - General Practice in Jbsa Lackland, TX

Q: What is the provider's specialty?

The provider's specialty is Dentist with taxonomy code 1223G0001X and a focus in General Practice.

Active since June 12, 2006

1615 TRUEMPER ST, JBSA LACKLAND, TX 78236(210) 539-7022 Get Directions Write a Review

NPPES record last updated: March 2, 2023. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Mar 2, 2023, Sep 20, 2021, May 14, 2019 (3 updates tracked since 2019).

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About Dr. Kelli C. Mack D.d.s. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KELLI C. MACK D.D.S. (NPI 1679515696) is an individual general practice provider in Jbsa Lackland, Texas, licensed in California (44021) and active in the NPI registry since June 2006. She maintains a secondary practice location in San Antonio.

NPPES Registry Identity

NPI1679515696

Entity TypeIndividualFemale

Primary Taxonomy1223G0001X

Provider Legal NameDR. KELLI C. MACKCredential: D.D.S.

Location Address1615 TRUEMPER STJbsa Lackland, TX 78236-5511

Mailing Address1615 Truemper StLackland Afb, TX 78236-5511 · (210) 539-7011

Phone(210) 539-7022

Sole ProprietorNo

Enumeration DateJune 12, 2006

Last NPPES UpdateMarch 2, 20233 updates tracked since enumeration

NPPES CertifiedMarch 1, 2023

✔ NPI 1679515696 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

Licenses✔ Licensed in CA · 44021✔ Licensed in TX · 21967

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Also ListedDentistTaxonomy 122300000X · License 44021 (CA)

1615 TRUEMPER ST, Jbsa Lackland, TX 78236

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