Individual provider · Type 1 NPI
Jack Kelly, DMD
Student in an Organized Health Care Education/Training Program · Waco, TX
NPI number
1679032452
Active
Practice location
609 Elm St
Waco, TX 76704-2516
Mailing address
51 Albion St Apt A4
Melrose, MA 02176-1859
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Student in an Organized Health Care Education/Training Program Primary | 390200000X | None listed |
Student in an Organized Health Care Education/Training Program: 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.
2 other providers at this address
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About NPI 1679032452
Jack Kelly, DMD's National Provider Identifier is 1679032452, issued on Mar 19, 2019. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Waco, TX. The record was last updated on Mar 19, 2019.