Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1679515696 Individual Practitioner Female Practitioner

Dr. Kelli C. Mack , DDS

Dentist - General Practice • Jbsa Lackland, TX

Professional Overview & Biography Verified Profile Summary

Dr. Kelli Mack, DDS is a registered healthcare professional specializing in Dentist - General Practice in Jbsa Lackland, TX. Practice services are available at 1615 TRUEMPER ST under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

1615 Truemper St

Jbsa Lackland, TX 782365511

Telephone 2105397022

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Jbsa Lackland, TX

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 12.3 Yrs
Regional Practice Density
39 Specialists

Practicing in Jbsa Lackland, TX (10570 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2023-03-01
Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License CA 44021

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.

Dentist

NUCC Taxonomy Code: 122300000X

State License CA 44021

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

Dentist - General Practice

NUCC Taxonomy Code: 1223G0001X

State License TX 21967

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.

Secondary Practice Locations

3551 Rodger Brooke Dr.

San Antonio, TX 78219

Phone: 2109164141

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

10 Associated Practitioners
Dr. Geoffrey Johnston , DDS

Dentist - Prosthodontics

NPI 1194265686

Doctor of Dental Surgery

Dr. Joseph Gedge , DDS

Dentist - General Practice

NPI 1225387558

Doctor of Dental Surgery

Dr. Rachel Weber , DDS

Dentist - Periodontics

NPI 1417943093

Doctor of Dental Surgery

NPI 1619377884

Doctor of Dental Medicine

Dr. Stephen Gasparovich , DDS

Dentist - Pediatric Dentistry

NPI 1699737825

Doctor of Dental Surgery

NPI 1790073609

Doctor of Dental Surgery, Doctor of Pharmacy (Pharm.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

11 Historical Events
🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) March 02, 2023

Dentist (License #44021 in CA)

📍
Updated Practice Location September 20, 2021

Registered at 1615 TRUEMPER ST, JBSA LACKLAND, TX 782365511 (Tel: 2105397022)

📍
Updated Business Mailing Address September 20, 2021

Registered at 1615 TRUEMPER ST, LACKLAND AFB, TX 782365511 (Tel: 2105397011)

📍
Updated Practice Location May 14, 2019

Registered at 101 BODIN CIR, TRAVIS AFB, CA 945351809 (Tel: 7074237072)

📍
Updated Business Mailing Address May 14, 2019

Registered at 101 BODIN CIR, TRAVIS AFB, CA 945351809 (Tel: 7074237072)

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 08, 2007

Registered at 1401 DESHLER ST SW, ATTN: AFRC-RMC-GMD-A, FORT MCPHERSON, GA 303301040 (Tel: 7709686319)

📍
Updated Business Mailing Address July 08, 2007

Registered at 9801 STONELAKE BLVD, #1031, AUSTIN, TX 787596579 (Tel: 5124611189)

👤
Provider Name / Credentials Updated July 08, 2007

Recorded as KELLI MACK, D.D.S.

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #21967 in TX)

🟢
Initial NPI Registration & Enumeration June 12, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1679515696
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 12, 2006
Last Update: March 02, 2023
Sole Proprietor: No

Mailing Address

1615 Truemper St

Lackland Afb, TX 782365511

Phone: 2105397011

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.