Crompton Park Oral Surgery and Implant Associates, LLP

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, LLP

Practice address

59 Quinsigamond Ave
Worcester, MA 01610-1806

Phone

(508) 799-2550

NPI assigned

Dec 10, 2007

Organization subpart

No

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

Authorized official

Name

W David Kelly, DMD

Title

Member

Phone

(508) 799-2550

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1197244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197244800000",
    "number": "1093998387",
    "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": "016101806",
            "telephone_number": "508-799-2550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 QUINSIGAMOND AVE",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016101806",
            "telephone_number": "508-799-2550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROMPTON PARK ORAL SURGERY AND IMPLANT ASSOCIATES, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-10",
        "last_updated": "2007-12-10",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "W DAVID",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "508-799-2550",
        "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": [],
    "endpoints": [],
    "other_names": []
}

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

• 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 Dec 10, 2007; 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.