Organization
CROMPTON PARK ORAL SURGERY AND IMPLANT ASSOCIATES, LLC
Active
Other names
W. David Kelly, DMD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. W DAVID KELLY DMD (SOLE MEMBER)
(508) 799-2550
Entity
Organization
Contact information
Practice address
59 QUINSIGAMOND AVE, WORCESTER, MA 01610-1867
(508) 799-2550
(508) 756-2923
Mailing address
59 QUINSIGAMOND AVE, WORCESTER, MA 01610-1867
(508) 799-2550
(508) 756-2923
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12222
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110009711A
—
MA
Enumeration date
04/07/2010
Last updated
06/11/2010
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