Keron Kamali Williams

Primary specialty

Dental AssistantTaxonomy code 126800000X

License

DA11484 Issued in MA

Practice address

12 Post Office SQ
Boston, MA 02109-3924

Phone

(212) 686-3686

NPI assigned

Aug 7, 2023

Last updated

Aug 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Life Bridge Dental Ma PLLC

  dba Tend Dental

  • General Practice Dentistry
  • Boston, MA
  • NPI 1730856196
  NPD

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

{
    "created_epoch": "1691366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1568144624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "97 ALLEN AVE",
            "city": "LYNN",
            "state": "MA",
            "postal_code": "019023532",
            "telephone_number": "978-715-5728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 POST OFFICE SQ",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021093924",
            "telephone_number": "212-686-3686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "KERON",
        "middle_name": "KAMALI",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-08-07",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "126800000X",
            "taxonomy_group": "",
            "desc": "Dental Assistant",
            "state": "MA",
            "license": "DA11484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Sylvan Williams, MD
• Joy Williams, NP
• June-Noelle Williams, MS, CCC-SLP
• Kaelyn Milan Williams
• Katherine Rachel Williams, PNP
• Kyle Allen Williams, M.D.
• Laurie Ann Williams, N.P.
• Lisa Faye Williams, NP
• Lucy Williams
• Margaret Williams

• Dental Assistant in Boston, MA
• Providers in Boston, MA by specialty
• Dental Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2023; 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.