| W. David Kelly, Dmd | |
|
59 Quinsigamond Ave Worcester MA 01610-1867 | |
| (508) 799-2550 | |
| (508) 756-2923 |
| Full Name | W. David Kelly, Dmd |
|---|---|
| Speciality | Dentist |
| Location | 59 Quinsigamond Ave, Worcester, Massachusetts |
| Authorized Official Name and Position | W David Kelly (SOLE MEMBER) |
| Authorized Official Contact | 5087992550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| W. David Kelly, Dmd 59 Quinsigamond Ave Worcester MA 01610-1867 Ph: (508) 799-2550 | W. David Kelly, Dmd 59 Quinsigamond Ave Worcester MA 01610-1867 Ph: (508) 799-2550 |
| NPI Number | 1033434659 |
|---|---|
| Provider Enumeration Date | 04/07/2010 |
| Last Update Date | 06/11/2010 |
| Medicare PECOS PAC ID | 7618132564 |
|---|---|
| Medicare Enrollment ID | O20120627000804 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033434659 | NPI | - | NPPES |
| 110009711A | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 12222 (Massachusetts) | Primary |
| Provider Name | W David Kelly |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1326041385 PECOS PAC ID: 9537324488 Enrollment ID: I20120627000794 |
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