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General NPI Number Information
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NPI Number | 1609145457
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Entity Type | Organization
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Legal Business Name | 42 NORTH DENTAL CARE, LLC
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Dates
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Enumeration Date | 12/23/2011
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 184 CAMBRIDGE ST
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City | BURLINGTON
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State | MA
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Zip | 01803-2911
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Country | US
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Telephone | 781-221-0072
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Fax |
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Provider Business Mailing Address
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Address Line | 200 5TH AVE FL 3
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City | WALTHAM
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State | MA
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Zip | 02451-8759
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Country | US
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Telephone | 781-647-0772
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Fax |
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Authorized Official
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Title or Position | CHIEF CLINICAL OFFICER
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Name | DR. MICHAEL ANGELO SCIALABBA
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Credential | DDS
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Telephone | 561-512-2709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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