Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jack Kelly, DMD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1679032452

Jack Kelly, DMD is a Student in an Organized Health Care Education/Training Program in Waco, Texas. Practices as a sole proprietor. Registered with an NPI since 2019.

In the registry since
2019
What do these letters mean?
DMD — Doctor of Dental Medicine
A dentist. Identical training and licensing to a DDS.

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Practice location Address checks out

609 Elm St
Waco, TX 76704-2516
Phone: (254) 313-6960
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1679032452
Entity typeIndividual (Type 1)
GenderMale
Credentials DMD
Sole proprietorYes
NPI enumeratedMarch 19, 2019
Last updated in NPPESMarch 19, 2019
Mailing address51 Albion St Apt A4, Melrose, MA 02176-1859

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