Kelli C. Mack, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

44021 Issued in CA

Practice address

1615 Truemper St
Jbsa Lackland, TX 78236-5511

Phone

(210) 539-7022

NPI assigned

Jun 12, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677715200000",
    "number": "1679515696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 TRUEMPER ST",
            "city": "LACKLAND AFB",
            "state": "TX",
            "postal_code": "782365511",
            "telephone_number": "210-539-7011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 TRUEMPER ST",
            "city": "JBSA LACKLAND",
            "state": "TX",
            "postal_code": "782365511",
            "telephone_number": "210-539-7022"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3551 Rodger Brooke Dr.",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "78219",
            "country_code": "US",
            "telephone_number": "210-916-4141",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACK",
        "first_name": "KELLI",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-12",
        "last_updated": "2023-03-02",
        "certification_date": "2023-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "44021",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "21967",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "44021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monica Michelle Lovasz, MD
• Janelle Lozano, M.A. CCC-SLP, CBIS
• Lucky Lusterio, D.O.
• Brandy Erin Ransom Lybeck, M.D.
• Vanessa Wai-Juen Lyons, MD
• Michael Madrid, M.D.
• Lukas Maier, PSY.D.
• Theresa McAlister Mairson, M.D.
• Yevgeniy Mikhaylovich Maksimenko, MD
• Monisha Fahim Malek, MD

• General Practice Dentistry in Jbsa Lackland, TX
• Providers in Jbsa Lackland, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.