Healthcare Provider Details

I. General information

NPI: 1477210219
Provider Name (Legal Business Name): SCOTT D CARADONNA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2021
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WILDEWOOD DR
LYNNFIELD MA
01940-1342
US

IV. Provider business mailing address

20 WILDEWOOD DR
LYNNFIELD MA
01940-1342
US

V. Phone/Fax

Practice location:
  • Phone: 617-997-7528
  • Fax:
Mailing address:
  • Phone: 617-997-7528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN1859251
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: