Provider Demographics
NPI:1730846403
Name:42 NORTH DENTAL ORAL SURGERY OF MA, PLLC
Entity type:Organization
Organization Name:42 NORTH DENTAL ORAL SURGERY OF MA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANGELO
Authorized Official - Last Name:SCIALABBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-512-2709
Mailing Address - Street 1:270 QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-8127
Mailing Address - Country:US
Mailing Address - Phone:617-773-9500
Mailing Address - Fax:
Practice Address - Street 1:270 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-8127
Practice Address - Country:US
Practice Address - Phone:617-773-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:42 NORTH DENTAL ORAL SURGERY OF MA, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental