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42 North Dental Care PLLC

Dentist, General Practice in Portland, ME. Organization (NPI-2).

NPI number1497346829
StatusActive
Last updated in NPPESMay 21, 2021

Details

NPI
1497346829
Entity type
Organization (NPI-2)
Legal business name
42 North Dental Care PLLC
Organization subpart
Yes
Enumeration date
Jan 28, 2021
Certification date
May 21, 2021
Last updated
May 21, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice––Yes
261QD0000X Clinic/Center, Dental––

Other names

  • Restorative And Aesthetic Dental Associates (Doing Business As)

Practice location

650 Brighton Ave
Portland, ME 04102-1035

Phone 207-773-6331

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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