42 NORTH DENTAL CARE, LLC — NPI 1205868098 (Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) in WALTHAM, MA)

CMS-1500 Box 24J / 33a • NPI

1205868098

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

122300000X (CMS C5)

Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)

Box 32 Service Location & ZIP+4

200 5TH AVE, WALTHAM, MA, 02451-8779

✓ 9-Digit EDI 837 ZIP+4 (02451-8779)

Practice Phone & Referral Fax

(781) 647-0772

Fax: (781) 647-1086

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1205868098 (42 NORTH DENTAL CARE, LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1205868098` (NPI-2 Organization / Facility)
Provider / Legal Name	42 NORTH DENTAL CARE, LLC
Plain-English Specialty	Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) NUCC Code: `122300000X` (Dentist)
Certifying / Licensing Body	American Dental Association (ADA) / State Board of Dental Examiners
Practice Location Address	200 5TH AVE, WALTHAM, MA, 02451-8779
Practice Telephone / Fax	Tel: (781) 647-0772 \| Fax: (781) 647-1086
Administrative Mailing Address	200 5TH AVE, WALTHAM, MA, 02451-8779
Enumeration & Last Sync	Enumerated: 2006-07-06 \| CMS Record Updated: 2021-06-21
Authorized Official	MICHAEL SCIALABBA (Chief Clinical Officer)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

200 5TH AVE, WALTHAM, MA, 02451-8779

🗺️ Open in Google Maps 🏥 More Providers in WALTHAM

🔒 Are you 42 NORTH DENTAL CARE, LLC? Get your Verified NPI Clinic Badge or request personal phone/address redaction →

Plain-English Taxonomy & CMS Crosswalk (122300000X)

What Does Taxonomy Code 122300000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 122300000X translates to:
"Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code C5 (Dentist)
Certifying / Accrediting Authority: American Dental Association (ADA) / State Board of Dental Examiners
Clinical Scope: Routine 6-month dental checkups, toothache, dental abscess, bleeding gums (periodontitis), or wisdom tooth extraction.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (42 NORTH DENTAL CARE, LLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Oral Evaluation, Digital Dental Radiographs & Prophylaxis
Restorative Composite Fillings, Crowns, Endodontic Root Canal & Extractions

Common Therapeutic Classes:

Amoxicillin, Metronidazole & Clindamycin (Odontogenic Infections)
Chlorhexidine Gluconate 0.12% Oral Rinse & High-Fluoride Varnish

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`204E00000X` — Oral & Maxillofacial Surgery Plain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — Oral & Maxillofacial Surgery	State: N/A \| License: `Verified` \| Primary: Secondary
`1223E0200X` — Dentist, Endodontics Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: N/A \| License: `Verified` \| Primary: Secondary
`1223G0001X` — Dentist, General Practice Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: N/A \| License: `Verified` \| Primary: Secondary
`1223P0221X` — Dentist, Pediatric Dentistry Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: N/A \| License: `Verified` \| Primary: Secondary
`1223P0300X` — Dentist, Periodontics Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: N/A \| License: `Verified` \| Primary: Secondary
`1223P0700X` — Dentist, Prosthodontics Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: N/A \| License: `Verified` \| Primary: Secondary
`1223X0400X` — Dentist, Orthodontics and Dentofacial Orthopedics Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: N/A \| License: `Verified` \| Primary: Secondary
`122300000X` — Dentist Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: MA \| License: `13328` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

Batch-verify up to 25 NPIs free against CMS NPPES + Medicare PECOS + HHS OIG Exclusions with 1-click CSV export.

Launch Bulk NPI Checker → JSON API Docs

42 NORTH DENTAL CARE, LLC (NPI #1205868098)