Provider Demographics
NPI: | 1952944340 |
---|---|
Name: | 42 NORTH DENTAL CARE PLLC |
Entity Type: | Organization |
Organization Name: | 42 NORTH DENTAL CARE PLLC |
Other - Org Name: | SUNRISE FAMILY DENTAL CARE |
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: | 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: | 160 ROBBINS ST |
Practice Address - Street 2: | |
Practice Address - City: | WATERBURY |
Practice Address - State: | CT |
Practice Address - Zip Code: | 06708-2652 |
Practice Address - Country: | US |
Practice Address - Phone: | 203-757-8855 |
Practice Address - Fax: | 203-757-0550 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | 42 NORTH DENTAL CARE PLLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2019-10-18 |
Last Update Date: | 2021-06-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QD0000X | Ambulatory Health Care Facilities | Clinic/Center | Dental |