Healthcare Provider Details

I. General information

NPI: 1104591502
Provider Name (Legal Business Name): TAYM ALMETWALI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 ROUTE 120 UNIT C
LEBANON NH
03766-1430
US

IV. Provider business mailing address

12 POST OFFICE SQ
BOSTON MA
02109-3924
US

V. Phone/Fax

Practice location:
  • Phone: 603-782-0329
  • Fax:
Mailing address:
  • Phone: 603-782-0329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1859722
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number04681
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: