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42 North Dental Care, LLC

Clinic/Center, Dental in Cambridge, MA. Organization (NPI-2).

NPI number1033765953
StatusActive
Last updated in NPPESJun 21, 2021

Details

NPI
1033765953
Entity type
Organization (NPI-2)
Legal business name
42 North Dental Care, LLC
Organization subpart
Yes
Enumeration date
Aug 15, 2019
Certification date
Jun 21, 2021
Last updated
Jun 21, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QD0000X Clinic/Center, Dental––Yes

Other names

  • Fresh Pond Dental (Doing Business As)

Practice location

180 Alewife Brook Pkwy
Cambridge, MA 02138-1102

Phone 617-539-2524

Mailing address

200 5th Ave Fl 3
Waltham, MA 02451-8759

Phone 781-647-0772

Authorized official

Michael Angelo Scialabba
Chief Clinical Officer
5615122709

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