NPI 1205868098 · live from the CMS NPI Registry
42 North Dental Care, LLC
Dentist in Waltham, MA. National Provider Identifier 1205868098, active.
NPI record
| NPI | 1205868098 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dentist 122300000X |
| Practice location | 200 5th Ave, Waltham, MA 02451 |
| Practice phone | 781-647-0772 |
| Enumerated | July 6, 2006 |
| Last updated | June 21, 2021 |
| Authorized official | Michael Scialabba, Chief Clinical Officer |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Oral & Maxillofacial Surgery | 204E00000X | — |
| Dentist, Endodontics | 1223E0200X | — |
| Dentist, General Practice | 1223G0001X | — |
| Dentist, Pediatric Dentistry | 1223P0221X | — |
| Dentist, Periodontics | 1223P0300X | — |
| Dentist, Prosthodontics | 1223P0700X | — |
| Dentist, Orthodontics and Dentofacial Orthopedics | 1223X0400X | — |
| Dentist primary | 122300000X | 13328 (MA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.