DR. KELLY WADE MACK (NPI# 1780702472) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780702472 |
| Entity Type | Individual |
| Full Name | DR. KELLY WADE MACK |
| Credential | DDS |
| Practice Address |
2200 Horseshoe Ln Longview TX 75605-5648 |
| Practice Telephone | 9037533673 |
| Practice Fax Number | 9037532637 |
| Mailing Telephone | 9037533673 |
| Mailing Fax Number | 9037532637 |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
12211 | TX | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578896460 | Kelly Mack | Speech-Language Pathologist | 2124 16th St, Boulder, CO 80302-4354 | 2009-09-10 |
| 1215184056 | Kelly Mack | Physical Therapist | 107 Holly Creek Dr, Irmo, SC 29063-8918 | 2008-08-23 |
| 1396813960 | Kelly Leigh Mack | Physician Assistant | 995 N. Prince Frederick Blvd, Suite 204, Prince Frederick, MD 20678 | 2006-12-01 |
| 1003468273 | Kelly Lynne Mack | Nurse Practitioner | 2215 Burdett Ave, Troy, NY 12180-2466 | 2019-07-09 |
| 1972933646 | Kelly Mack | Physical Therapy Assistant | 44480 W Honeycutt Rd, #106, Maricopa, AZ 85138-2903 | 2013-11-17 |
| 1164692455 | Kelly Jene Mack | Counselor | 3737 Portland Rd Ne, Salem, OR 97301-0311 | 2008-03-03 |
| 1457471542 | Kelly S Mack | Nurse Practitioner | 6001 Research Park Blvd, Madison, WI 53719 | 2007-03-30 |
| 1982742888 | Kelly C Mack | Nurse Practitioner | 1800 Williams St, Suite 200, Denver, CO 80218-1234 | 2007-02-02 |
| 1245308899 | Kelly Anne Mack | Dental Hygienist | 55 E Loop Rd, Grove Dental Assoc Suite 201, Wheaton, IL 60187 | 2006-12-01 |
| Street Address |
2200 HORSESHOE LN |
| City | LONGVIEW |
| State | TX |
| Zip Code | 75605-5648 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497303283 | Baleigh Paige Trull | Dentist | 2200 Horseshoe Ln, Longview, TX 75605-5648 | 2019-08-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194353730 | Dusty Rae Hane | Nurse Practitioner | Diagnostic Clinic of Longview, 2901 N Fourth St, Longview, TX 75605 | 2020-03-30 |
| 1831720374 | Kaycee Whatley | Nurse Practitioner | 323 W Hawkins Parkway, Longview, TX 75605 | 2020-02-03 |
| 1245733492 | Somers Pediatrics | Pediatrics | 103 W. Loop 281, Suite 474, Longview, TX 75605 | 2018-03-14 |
| 1467838391 | Piney Woods Er II LLC | Clinic/Center | 120 East Loop 281, Longview, TX 75605 | 2015-08-03 |
| 1386023968 | Elizabeth Ann Heeb Tidwell | Obstetrics & Gynecology | 802 Medical Dr Ste 100, Longview, TX 75605 | 2015-05-28 |
| 1215353651 | Tracy Hicks | Nurse Practitioner | 102 Commander Dr Ste 9, Longview, TX 75605 | 2014-03-10 |
| 1073881280 | Deirdre Scotter | Specialist/Technologist | 201 E Tomlinson Pkwy, Longview, TX 75605 | 2011-12-02 |
| 1316230139 | Traditions Hospice of Longview, LLC | Hospice Care, Community Based | 4362 N Us Hwy 259, Suite B, Longview, TX 75605 | 2011-05-26 |
| 1184916769 | Telema Dikibujiri Nga | Pediatrics | Longview Regional Medical Center, 2901 North Fourth Street, Longview, TX 75605 | 2011-05-13 |
| 1902101108 | The Veta Lewis Behavioral Health Group | Counselor | 1800 S. Judson St., Suite 100, Longview, TX 75605 | 2011-01-19 |
| Find all providers in zip 75605 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| 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. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124681564 | Travis L Kendall Dds Pllc | Dentist | 444 Forest Sq Ste E, Longview, TX 75605-4463 | 2019-04-22 |
| 1609349612 | Sds-bill Owens Pkwy Pllc | Dentist | 3 Doctor Cir, Longview, TX 75605-5050 | 2019-01-03 |
| 1699272088 | Gur Simran Aurora | Dentist | 3052 N Eastman Rd Ste 108, Longview, TX 75605-5013 | 2018-04-11 |
| 1801301643 | Sds-bill Owens Pkwy Pllc | Dentist | 2840 Bill Owens Pkwy Ste B, Longview, TX 75605-2150 | 2017-12-01 |
| 1780104836 | Timothy John Gengel | Dentist | 444 Forest Sq Ste 1, Longview, TX 75605-4400 | 2017-06-20 |
| 1154878551 | Olivia Joelle Ndoutoume | Dentist | 2801 Bill Owens Pkwy, Apt 279, Longview, TX 75605-2115 | 2016-09-02 |
| 1659793396 | Jared A Franson, Dmd, Ps | Dentist | 2020 9th Ave Ste A, Longview, WA 98632-4072 | 2014-01-15 |
| 1619300332 | Robert Byron Shelton | Dentist | 905 Walnut Hill Dr Ste 1, Longview, TX 75605-5084 | 2013-08-16 |
| 1790128189 | Shiney George | Dentist | 710 Estes Dr, Longview, TX 75602-6120 | 2013-04-16 |
| 1740560911 | Mark D Teigen Dds Ps | Dentist | 1105 14th Ave, Longview, WA 98632-3016 | 2011-08-19 |
| Find all providers in LONGVIEW | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.