Organization · NPI-2

42 North Dental Care, LLC

Dentist · Waltham, MA

NPI number1205868098

StatusActive

Last updated in NPPESJun 21, 2021

Details

NPI: 1205868098
Entity type: Organization (NPI-2)
Legal business name: 42 North Dental Care, LLC
Organization subpart: No
Enumeration date: Jul 6, 2006
Certification date: Jun 21, 2021
Last updated: Jun 21, 2021

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
122300000X	Dentist	13328	MA	Yes
204E00000X	Oral & Maxillofacial Surgery	–	–
1223E0200X	Dentist, Endodontics	–	–
1223G0001X	Dentist, General Practice	–	–
1223P0221X	Dentist, Pediatric Dentistry	–	–
1223P0300X	Dentist, Periodontics	–	–
1223P0700X	Dentist, Prosthodontics	–	–
1223X0400X	Dentist, Orthodontics and Dentofacial Orthopedics	–	–

Practice location

200 5th Ave
Waltham, MA 02451-8779

Phone 781-647-0772 · Fax 781-647-1086

Mailing address

200 5th Ave
Waltham, MA 02451-8779

Phone 781-647-0772 · Fax 781-647-1086

Authorized official

Michael Angelo Scialabba
Chief Clinical Officer
5615122709

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