42 NORTH DENTAL CARE, PLLC — NPI 1528130283 (Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) in PORTLAND, ME)

CMS-1500 Box 24J / 33a • NPI

1528130283

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

650 BRIGHTON AVE, PORTLAND, ME, 04102-1035

✓ 9-Digit EDI 837 ZIP+4 (04102-1035)

Practice Phone & Referral Fax

(207) 773-6331

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1528130283 (42 NORTH DENTAL CARE, PLLC) 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	`1528130283` (NPI-2 Organization / Facility)
Provider / Legal Name	42 NORTH DENTAL CARE, PLLC
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	650 BRIGHTON AVE, PORTLAND, ME, 04102-1035
Practice Telephone / Fax	Tel: (207) 773-6331
Administrative Mailing Address	650 BRIGHTON AVE, PORTLAND, ME, 04102-1035
Enumeration & Last Sync	Enumerated: 2006-11-15 \| CMS Record Updated: 2021-12-29
Authorized Official	MICHAEL SCIALABBA (Chief Clinical Officer)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

650 BRIGHTON AVE, PORTLAND, ME, 04102-1035

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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, PLLC)

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
`122300000X` — Dentist Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: ME \| License: `2954` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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42 NORTH DENTAL CARE, PLLC (NPI #1528130283)