42 North Dental Care of Indiana, LLC

NPI #1679225965 in Waltham, Massachusetts

Provider Information

NPI Number
1679225965
Entity Type
Organization
Organization Name
42 North Dental Care of Indiana, LLC
Subpart
Yes (part of a larger organization)
Parent Organization
42 NORTH DENTAL CARE OF INDIANA, LLC
Primary Specialty
Clinic/Center - Dental
Enumeration Date
Jan 19, 2022
Last Updated
Jan 19, 2022

Practice Location

Address
200 5TH AVE FL 3
ZIP Code
02451-8759
Phone
(781) 647-0772

Authorized Official

Name
MICHAEL ANGELO SCIALABBA
Title
CHIEF CLINICAL OFFICER
Phone
(561) 512-2709

Specialties & Taxonomy Codes

Specialty
Clinic/Center - DentalDental

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