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1780702472
KELLY WADE MACK
LONGVIEW, TX
NPI
1780702472
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1223G0001X Dentist, General Practice
(Licence: TX 12211)
Enumeration Date
2007-03-27
Last Update Date
2007-07-08
Business Address
Dr. KELLY WADE MACK dds
2200 HORSESHOE LN
LONGVIEW, TX 75605-5648
Phone number: 903-753-3673
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Mailing Address
Dr. KELLY WADE MACK dds
2200 HORSESHOE LN
LONGVIEW, TX 75605-5648
Phone number: 903-753-3673
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