Provider Demographics
NPI:1740722487
Name:42 NORTH DENTAL CARE, PLLC
Entity type:Organization
Organization Name:42 NORTH DENTAL CARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:118 ELM STREET
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082
Practice Address - Country:US
Practice Address - Phone:860-749-6088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:42 NORTH DENTAL CARE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-11
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental