MEDICARE: DR. KELLI C. MACK D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	44021	CA
2	1223G0001X	General Practice Dentistry	21967	TX
3	1223G0001X	General Practice Dentistry	44021	CA

General Provider Information

NPI Number	:	1679515696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLI C. MACK D.D.S.

Provider Business Mailing Address
First Line	:	1615 TRUEMPER ST
Second Line	:
City	:	LACKLAND AFB
State	:	TX
Zip	:	78236-5511
Country	:	US
Telephone Number	:	210-539-7011
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 TRUEMPER ST
Second Line	:
City	:	JBSA LACKLAND
State	:	TX
Zip	:	78236-5511
Country	:	US
Telephone Number	:	210-539-7022
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	03/02/2023

Similar Medicare Providers

1801880588 — DR. DAVID L MAPES D.D.S.
Practice Location Address:

1615 TRUEMPER ST
JBSA LACKLAND, TX
78236-5511

Practice Phone: 210-671-9970
Practice Fax:

1417943093 — RACHEL WEBER DDS
Practice Location Address:

1615 TRUEMPER ST
JBSA LACKLAND, TX
78236-5511

Practice Phone: 210-292-0749
Practice Fax:

1831189794 — DR. ALLAN S PARKE DDS
Practice Location Address:

1615 TRUEMPER ST BLDG 6418
JBSA LACKLAND, TX
78236-5511

Practice Phone: 210-292-1035
Practice Fax:

1194707554 — DR. JAMES M YOUNG DDS
Practice Location Address:

1615 TRUEMPER ST BLDG 6418
JBSA LACKLAND, TX
78236-5511

Practice Phone: 210-292-0650
Practice Fax:

1932183282 — DR. COREY RAWLINS ANDERSON D.S.S., M.S.
Practice Location Address:

1615 TRUEMPER ST BLDG 6418
JBSA LACKLAND, TX
78236-5511

Practice Phone: 757-913-2847
Practice Fax:

1699737825 — STEPHEN RICHARD GASPAROVICH DDS
Practice Location Address:

1615 TRUEMPER ST
JBSA LACKLAND, TX
78236-5511

Practice Phone: 210-292-0123
Practice Fax:

Directions to “ DR. KELLI C. MACK D.D.S.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.