NPI 1033434659

Crompton Park Oral Surgery and Implant Associates, LLC

Organisation Oral and Maxillofacial Surgery (Dentist) Worcester, MA

Practice location

Address: 59 Quinsigamond Ave, Worcester, MA 01610-1867
Phone: (508) 799-2550
Fax: (508) 756-2923

Authorised official

Name: W David Kelly
Title: Sole Member
Phone: (508) 799-2550

Registered specialties

Oral and Maxillofacial Surgery (Dentist) Primary

Dental Providers Taxonomy 1223S0112X Licence 12222 (MA)

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Registry record

NPI: 1033434659
Entity type: Organization
NPI issued: 7 Apr 2010
Record last updated: 11 Jun 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.