42 North Dental Oral Surgery of Ma, PLLC
Organization Active NPI Dental Clinic/Center · Waltham, MA
NPI 1043979040 · NPPES record last updated Dec 17, 2021
Key facts
- NPI
- 1043979040
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dental Clinic/Center 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
- Organization subpart
- Yes
- Parent organization (as reported)
- 42 NORTH DENTAL ORAL SURGERY OF MA, PLLC
Authorized official
- Name
- Dr. Michael Angelo Scialabba
- Title
- Chief Clincal Officer
- Phone
- (561) 512-2709
Corporate family (same tax ID) 1
National Provider Directory
- Tax ID family
- 42 North Dental Oral Surgery of Ma PLLC
- Part of
- 42 North Dental Oral Surgery of Ma PLLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | Yes |
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
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All providers in Waltham, MA · Dental Clinic/Center in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.