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Jack Kelly, DMD
Student in an Organized Health Care Education/Training Program in Waco, Texas
NPI 1679032452

Jack Kelly is a Student in an Organized Health Care Education/Training Program based in Melrose, TX. Jack Kelly practices in Waco, TX and has the professional credentials of DMD. The NPI Number for Jack Kelly is 1679032452 and holds a License No. (Texas).

The current practice location address for Jack Kelly is 609 Elm St, Waco, TX and can be reached out via phone at 254-313-6960. You can also correspond with Jack Kelly through the mailing address at 51 ALBION ST APT A4, MELROSE, MA - 02176-1859 (mailing address contact number: ).

Location: 609 Elm St, Waco, TX, 02176-1859
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1679032452
Provider Name
Jack Kelly
Credential
DMD
Provider Entity Type
Individual
Gender
Male
Address
609 Elm St, Waco, TX, 02176-1859
Phone Number
254-313-6960
Fax Number
Provider Enumeration Date
03/19/2019
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
609 Elm St
City
Waco
State
Texas
Zip
76704-2516
Phone Number
254-313-6960
Fax Number
person
Provider Business Mailing Address Details
Address
609 Elm St
City
Waco
State
Texas
Zip
76704-2516
Phone Number
254-313-6960
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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