Crompton Park Oral Surgery and Implant Associates, LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

12222 Issued in MA

Legal business name

CROMPTON PARK ORAL SURGERY AND IMPLANT ASSOCIATES, LLC

Doing business as

W. David Kelly, DMD

Practice address

59 Quinsigamond Ave
Worcester, MA 01610-1867

Phone

(508) 799-2550

Fax

(508) 756-2923

NPI assigned

Apr 7, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. W David Kelly, DMD

Title

Sole Member

Phone

(508) 799-2550

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• W. David Kelly, DMD Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1270598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276214400000",
    "number": "1033434659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 QUINSIGAMOND AVE",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016101867",
            "telephone_number": "508-799-2550",
            "fax_number": "508-756-2923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 QUINSIGAMOND AVE",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016101867",
            "telephone_number": "508-799-2550",
            "fax_number": "508-756-2923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROMPTON PARK ORAL SURGERY AND IMPLANT ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-07",
        "last_updated": "2010-06-11",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "W DAVID",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "508-799-2550",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MA",
            "license": "12222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110009711A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "W. David Kelly, DMD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kathryn Crocker
• Jennifer Mary Croft, LCSW
• Mark Croft, RN
• Sophia Mary Croft
• Alysha L Croke, DPT
• Crompton Park Oral Surgery and Implant Associates, LLP
• Kristi Anne Cromwell, M.A., CCC-SLP
• Darcy Cronin, M.S., BCBA, LABA
• Matthew George Cronin, PA-C
• Nathaniel Thomas Crook

• Oral and Maxillofacial Surgery (Dentist) in Worcester, MA
• Providers in Worcester, MA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.