Individual provider Active NPI

Taym Almetwali, DMD

  • Dentist
  • Lebanon, NH
National Provider Identifier
1104591502
Registry record updated Jan 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN1859722 Issued in MA
Practice address
367 Route 120 Unit C
Lebanon, NH 03766-1430
Phone
(603) 782-0329
NPI assigned
Aug 9, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 04681 NH
Dentist 122300000X DN1859722 MA Primary

Addresses

Primary practice location

367 Route 120 Unit C
Lebanon, NH 03766-1430

Mailing address

12 Post Office SQ
Boston, MA 02109-3924
Phone (603) 782-0329

Other practice location 1

12 Post Office Sq
Boston, MA 02109-3924
Phone (212) 686-3686

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DN1859722MAMDDentist
04681NHMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Life Bridge Dental Ma PLLC General Practice CurrentSince Jan 5, 2025 Accepting new patients

Locations

12 Post Office Sq
Boston, MA 02109
Phone (617) 542-8808

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1628467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735862400000",
    "number": "1104591502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 POST OFFICE SQ",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021093924",
            "telephone_number": "603-782-0329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "367 ROUTE 120 UNIT C",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037661430",
            "telephone_number": "603-782-0329"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12 Post Office Sq",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021093924",
            "country_code": "US",
            "telephone_number": "212-686-3686",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ALMETWALI",
        "first_name": "TAYM",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-09",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NH",
            "license": "04681",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1859722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.