Healthcare Provider Details

I. General information

NPI: 1871466946
Provider Name (Legal Business Name): NORTH DENTAL OF MASSACHUSETTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 QUINCY AVE STE A
QUINCY MA
02169-8127
US

IV. Provider business mailing address

270 QUINCY AVE STE A
QUINCY MA
02169-8127
US

V. Phone/Fax

Practice location:
  • Phone: 617-773-9500
  • Fax:
Mailing address:
  • Phone: 617-773-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ANGELO SCIALABBA
Title or Position: CHIEF CLINICAL OFFICER
Credential:
Phone: 561-512-2709