Organization
42 NORTH DENTAL CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL ANGELO SCIALABBA DDS (CHIEF CLINICAL OFFICER)
(561) 512-2709
Entity
Organization
Contact information
Practice address
200 5TH AVE, WALTHAM, MA 02451-8779
(781) 647-0772
(781) 647-1086
Mailing address
200 5TH AVE, WALTHAM, MA 02451-8779
(781) 647-0772
(781) 647-1086
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
13328
MA
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
Other
Enumeration date
07/06/2006
Last updated
06/21/2021
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