W David Kelly, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

12222 Issued in MA

Practice address

59 Quinsigamond Ave
Worcester, MA 01610-1867

Phone

(508) 799-2550

Fax

(508) 756-2923

NPI assigned

May 24, 2005

Reactivated

Mar 20, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329436800000",
    "number": "1326041385",
    "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": {
        "last_name": "KELLY",
        "first_name": "W",
        "middle_name": "DAVID",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2012-02-17",
        "deactivation_date": "2006-03-16",
        "reactivation_date": "2006-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MA",
            "license": "12222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul V Kelly, RN
• Ryan Patrick Kelly, MD
• Sabrina M. Kelly, NP
• Sarah Kelly, PT, DPT
• Tayla Kelly
• Kelsuby Health & Wellness, LLC
• Emily Kemme, PA-C
• Judith S Kempfle, MD
• Alyssa Enman Kempskie, LMHC
• Robin Kempskie, LMHC

• 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 Feb 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.