NPIMap

Organization Active NPI

42 North Dental Oral Surgery of Ma, PLLC

  • Dental Clinic/Center
  • Waltham, MA
National Provider Identifier
1043979040
Registry record updated Dec 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
42 NORTH DENTAL ORAL SURGERY OF MA, PLLC
Practice address
200 5TH Ave FL 3
Waltham, MA 02451-8759
Phone
(781) 647-0772
NPI assigned
Dec 17, 2021
Last updated
Dec 17, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
42 NORTH DENTAL ORAL SURGERY OF MA, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 17, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Michael Angelo Scialabba
Title
Chief Clincal Officer
Phone
(561) 512-2709

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

200 5TH Ave FL 3
Waltham, MA 02451-8759

Mailing address

200 5TH Ave FL 3
Waltham, MA 02451-8759
Phone (781) 647-0772

National Provider Directory

National Provider Directory
Tax ID family
42 North Dental Oral Surgery of Ma PLLC2 organizations share this tax ID, including this one
Part of
42 North Dental Oral Surgery of Ma PLLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639699200000",
    "number": "1043979040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 5TH AVE FL 3",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024518759",
            "telephone_number": "781-647-0772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 5TH AVE FL 3",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024518759",
            "telephone_number": "781-647-0772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "42 NORTH DENTAL ORAL SURGERY OF MA, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "42 NORTH DENTAL ORAL SURGERY OF MA, PLLC",
        "enumeration_date": "2021-12-17",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A",
        "authorized_official_last_name": "SCIALABBA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ANGELO",
        "authorized_official_title_or_position": "CHIEF CLINCAL OFFICER",
        "authorized_official_telephone_number": "561-512-2709",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waltham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.