Provider Demographics
NPI:1700161478
Name:GREAT HILL DENTAL PARTNERS, LLC
Entity Type:Organization
Organization Name:GREAT HILL DENTAL PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
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 1:1610 TREMONT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120-1613
Practice Address - Country:US
Practice Address - Phone:617-713-3701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty