W DAVID KELLY (NPI# 1326041385) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1326041385 |
Entity Type | Individual |
Full Name | W DAVID KELLY |
Credential | DMD |
Practice Address |
59 Quinsigamond Ave Worcester MA 01610-1867 |
Practice Telephone | 5087992550 |
Practice Fax Number | 5087562923 |
Mailing Telephone | 5087992550 |
Mailing Fax Number | 5087562923 |
Enumeration Date | 2005-05-24 |
Last Update Date | 2012-02-17 |
NPI Deactivation Date | 03/16/2006 |
NPI Reactivation Date | 2006-03-20 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
12222 | MA | Dental Providers |
Street Address |
59 QUINSIGAMOND AVE |
City | WORCESTER |
State | MA |
Zip Code | 01610-1867 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1811313513 | Seth A. Brawer | Physician Assistant | 59 Quinsigamond Ave, Worcester County Orthopedics, Worcester, MA 01610-1867 | 2014-03-05 |
1033434659 | Crompton Park Oral Surgery and Implant Associates, LLC | Dentist | 59 Quinsigamond Ave, Worcester, MA 01610-1867 | 2010-04-07 |
1093998387 | Crompton Park Oral Surgery and Implant Associates, LLP | Dentist | 59 Quinsigamond Ave, Worcester, MA 01610-1806 | 2007-12-10 |
1841313921 | Philip J Lahey | Orthopaedic Surgery | 59 Quinsigamond Ave, Ste 200, Worcester, MA 01610-1867 | 2007-04-06 |
1104850528 | Christopher Jay Vinton | Orthopaedic Surgery | 59 Quinsigamond Ave, Worcester County Orthopedics, Worcester, MA 01610-1806 | 2006-07-10 |
1376528323 | Philip J. Lahey Jr. | Specialist | 59 Quinsigamond Ave, Worcester, MA 01610-1806 | 2005-12-13 |
1396720348 | Worcester County Orthopedics | Specialist | 59 Quinsigamond Ave, Worcester, MA 01610-1806 | 2005-12-13 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1881189355 | Amber Hall | Counselor | 26 Queen St, 6th Floor, Worcester, MA 01610 | 2018-06-27 |
1417401951 | Kelsey Moran | Counselor | 1 College Street, Box D, Worcester, MA 01610 | 2016-08-13 |
1245685809 | Walter Trisdale | Specialist/Technologist | One College St., College of The Holy Cross, Worcester, MA 01610 | 2016-05-02 |
1669866430 | Shannon Smith | Student in an Organized Health Care Education/Training Program | 26 Queen St, Ground Floor, Ambulatory Psychiatry Service, Ummmc, Worcester, MA 01610 | 2015-03-19 |
1063815348 | Terri Boettcher | Social Worker | 72 Jacques Street, Worcester, MA 01610 | 2014-10-01 |
1700222866 | Kalynn Lucashensky | Occupational Therapist | 105 Woodland St. Apt. A, Worcester, MA 01610 | 2013-05-16 |
1093053993 | Chrissy Marie Ryan | Registered Nurse | 26 Queen St 6th Floor, Flow Pact, Worcester, MA 01610 | 2013-01-28 |
1851681324 | Renaissance Adult Day Care, LLC | Clinic/Center | 1040 Southbridge Street, Worcester, MA 01610 | 2011-04-18 |
1912203217 | Goddard/homestead | Custodial Care Facility | 10 Homestead Avenue, Worcester, MA 01610 | 2011-02-03 |
1912173196 | Rahman Ullah | Dentist | Park Ave Dental Center, 456 Park Avenue, Worchester, MA 01610 | 2008-05-07 |
Find all providers in zip 01610 |
Taxonomy Code | 1223S0112X |
Grouping | Dental Providers |
Classification | Dentist |
Specialization | Oral and Maxillofacial Surgery |
The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
Notes: Source: Council on Dental Education and Licensure, American Dental Association |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1245249820 | Xue Yu Shen | Dentist | 9 Linden Street, Worcester, MA 01609 | 2006-08-05 |
1982149514 | Oral Surgery Partners PC | Dentist | 388 Park Ave, Worcester, MA 01610-1025 | 2017-01-06 |
1033434659 | Crompton Park Oral Surgery and Implant Associates, LLC | Dentist | 59 Quinsigamond Ave, Worcester, MA 01610-1867 | 2010-04-07 |
1679747398 | Bay State Oral Surgery Associates, Inc. | Dentist | 9 Linden Street, Worcester, MA 01609 | 2008-04-14 |
1093998387 | Crompton Park Oral Surgery and Implant Associates, LLP | Dentist | 59 Quinsigamond Ave, Worcester, MA 01610-1806 | 2007-12-10 |
1295941607 | Laurie Manthos | Dentist | 200 Lincoln St, Suite 1, Worcester, MA 01605-2528 | 2007-05-15 |
1285750596 | Laurie Manthos, D.m.d., P.C. | Dentist | 200 Lincoln St, Suite 1, Worcester, MA 01605-2528 | 2007-03-21 |
1053470740 | Worcester Oral Surgery, P.C. | Dentist | 299 Lincoln Street, Suite 204, Worcester, MA 01605-3609 | 2006-12-08 |
1225109903 | Jasjit Singh Gill | Dentist | 299 Lincoln St, Suite 204, Worcester, MA 01605-3609 | 2006-11-13 |
1659442325 | Christopher Kevin Clancy | Dentist | 299 Lincoln St, Suite 204, Worcester, MA 01605-3609 | 2006-11-13 |
Find all providers in WORCESTER |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.