Provider Demographics
NPI:1356040190
Name:42 NORTH DENTAL CARE, LLC
Entity type:Organization
Organization Name:42 NORTH DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF DENTAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANGELO
Authorized Official - Last Name:SCIALABBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-512-2709
Mailing Address - Street 1:PO BOX 411381
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-1381
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1410 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1673
Practice Address - Country:US
Practice Address - Phone:781-630-7440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:42 NORTH DENTAL CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental