# 42 NORTH DENTAL CARE OF INDIANA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** 42 NORTH DENTAL CARE OF INDIANA, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1164171609
- **Legal business name:** 42 NORTH DENTAL CARE OF INDIANA, LLC
- **Authorized official:** MICHAEL ANGELO SCIALABBA (CHIEF CLINICAL OFFICER)
- **Authorized official phone:** (561) 512-2709

## Contact information

- **Practice address:** 7202 N SHADELAND AVE STE A, INDIANAPOLIS, IN 46250-2086
- **Practice address phone:** (317) 577-2578
- **Mailing address:** 7202 N SHADELAND AVE STE A, INDIANAPOLIS, IN 46250-2086

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 03/22/2022
- **Last updated:** 03/22/2022