Provider Demographics
NPI: | 1235761685 |
---|---|
Name: | 42 NORTH DENTAL CARE, PLLC |
Entity Type: | Organization |
Organization Name: | 42 NORTH DENTAL CARE, PLLC |
Other - Org Name: | GENTLE DENTAL SOUTH NASHUA |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CHIEF CLINICAL OFFICER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | ANGELO |
Authorized Official - Last Name: | SCIALABBA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 561-512-2709 |
Mailing Address - Street 1: | 200 5TH AVE FL 3 |
Mailing Address - Street 2: | |
Mailing Address - City: | WALTHAM |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02451-8759 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 781-647-0772 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 225 DANIEL WEBSTER HWY |
Practice Address - Street 2: | |
Practice Address - City: | SOUTH NASHUA |
Practice Address - State: | NH |
Practice Address - Zip Code: | 03060 |
Practice Address - Country: | US |
Practice Address - Phone: | 603-505-4190 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | 42 NORTH DENTAL CARE PLLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2020-02-04 |
Last Update Date: | 2021-05-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QD0000X | Ambulatory Health Care Facilities | Clinic/Center | Dental |