Active NPI
Timothy Michael Lethin
- General Practice Dentistry
- Anchorage, AK
National Provider Identifier
1104838077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1133
- Practice address
- 2601 Boniface Pkwy
Anchorage, AK 99504-3106 - Phone
- (907) 337-9474
- Fax
- (907) 337-9476
- NPI assigned
- Aug 12, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1133 | AK | Primary |
Addresses
Primary practice location
2601 Boniface Pkwy
Anchorage, AK 99504-3106
Mailing address
2601 Boniface Pkwy
Anchorage, AK 99504-3106
Phone (907) 337-9474
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1622826 | Other | AK | UCCI |
| DD6052 | Medicaid | AK |
Other names 1
- Dr. Timothy Michael Lethin
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 22, 2016 through Feb 22, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1133 | AK | MD | Clinical Social Worker |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dentist
- Anchorage, AK
- NPI 1861752560
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104838077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2601 BONIFACE PKWY",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995043106",
"telephone_number": "907-337-9474",
"fax_number": "907-337-9476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2601 BONIFACE PKWY",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995043106",
"telephone_number": "907-337-9474",
"fax_number": "907-337-9476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LETHIN",
"first_name": "TIMOTHY",
"middle_name": "MICHAEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AK",
"license": "1133",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCCI",
"identifier": "1622826",
"state": "AK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "DD6052",
"state": "AK"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "TIMOTHY",
"last_name": "LETHIN",
"middle_name": "MICHAEL",
"prefix": "DR.",
"credential": "DDS",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Anchorage, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.