42 North Dental Oral Surgery Of Ma, PLLC
Clinic/Center, Dental in Waltham, MA. Organization (NPI-2).
NPI number1043979040
StatusActive
Last updated in NPPESDec 17, 2021
Details
- NPI
- 1043979040
- Entity type
- Organization (NPI-2)
- Legal business name
- 42 North Dental Oral Surgery Of Ma, PLLC
- Organization subpart
- Yes
- Enumeration date
- Dec 17, 2021
- Certification date
- Dec 17, 2021
- Last updated
- Dec 17, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Practice location
200 5th Ave Fl 3Waltham, MA 02451-8759
Phone 781-647-0772
Mailing address
200 5th Ave Fl 3Waltham, MA 02451-8759
Phone 781-647-0772
Authorized official
Michael Angelo Scialabba
Chief Clincal Officer
5615122709
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All 22 Dental Clinic/Center providers in Waltham · All 2,572 providers in Waltham
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