NPIMap

Organization Active NPI

42 North Dental Care, LLC

  • Dentist
  • Waltham, MA
National Provider Identifier
1205868098
Registry record updated Jun 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
13328 Issued in MA
Legal business name
42 NORTH DENTAL CARE, LLC
Practice address
200 5TH Ave
Waltham, MA 02451-8779
Phone
(781) 647-0772
Fax
(781) 647-1086
NPI assigned
Jul 6, 2006
Last updated
Jun 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2021

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

Authorized official

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

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 13328 MA Primary
Endodontics 1223E0200X NU
General Practice Dentistry 1223G0001X NU
Pediatric Dentistry 1223P0221X NU
Periodontics 1223P0300X NU
Prosthodontics 1223P0700X NU
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X NU
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X NU

Addresses

Primary practice location

200 5TH Ave
Waltham, MA 02451-8779

Mailing address

200 5TH Ave
Waltham, MA 02451-8779
Phone (781) 647-0772

National Provider Directory

National Provider Directory
Tax ID family
42 North Dental Care LLC54 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

200 5th Ave
Waltham, MA 02451

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624233600000",
    "number": "1205868098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 5TH AVE",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024518779",
            "telephone_number": "781-647-0772",
            "fax_number": "781-647-1086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 5TH AVE",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024518779",
            "telephone_number": "781-647-0772",
            "fax_number": "781-647-1086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "42 NORTH DENTAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A",
        "authorized_official_last_name": "SCIALABBA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ANGELO",
        "authorized_official_title_or_position": "CHIEF CLINICAL OFFICER",
        "authorized_official_telephone_number": "561-512-2709",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "13328",
            "primary": true
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "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 Jun 21, 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.