# CROMPTON PARK ORAL SURGERY AND IMPLANT ASSOCIATES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** W. David Kelly, DMD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033434659
- **Authorized official:** DR. W DAVID KELLY DMD (SOLE MEMBER)
- **Authorized official phone:** (508) 799-2550

## Contact information

- **Practice address:** 59 QUINSIGAMOND AVE, WORCESTER, MA 01610-1867
- **Practice address phone:** (508) 799-2550
- **Practice address fax:** (508) 756-2923
- **Mailing address:** 59 QUINSIGAMOND AVE, WORCESTER, MA 01610-1867
- **Mailing address phone:** (508) 799-2550
- **Mailing address fax:** (508) 756-2923

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 12222 | MA | Yes |

## Other

- **Enumeration date:** 04/07/2010
- **Last updated:** 06/11/2010