IndividualActive
Jack Kelly, DMD
NPI 1679032452 · Student in an Organized Health Care Education/Training Program · Waco, TX
Provider details
- NPI number
- 1679032452
- Entity type
- Individual
- Primary specialty
- Student in an Organized Health Care Education/Training ProgramStudent, Health Care
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- Yes
Specialties & taxonomies
Student, Health Care
Profile Score
Established profile(60/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
7 yrs in NPPES registry
- Profile completeness38% of score
83% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
609 Elm St
Waco, TX 76704-2516
Phone: (254) 313-6960
Street-level locationGet directions
Mailing address
51 Albion St Apt A4
Melrose, MA 02176-1859
Registry dates
- Enumerated
- 2019-03-19
- Last updated
- 2019-03-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.