Healthcare Provider Details

I. General information

NPI: 1538612072
Provider Name (Legal Business Name): 42 NORTH DENTAL CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 S MAIN ST
CONCORD NH
03301-3483
US

IV. Provider business mailing address

200 5TH AVE FL 3
WALTHAM MA
02451-8759
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-1851
  • Fax:
Mailing address:
  • Phone: 781-647-0772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

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