Healthcare Provider Details

I. General information

NPI: 1558285353
Provider Name (Legal Business Name): GK DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGHLAND AVE STE 201
SALEM MA
01970-2702
US

IV. Provider business mailing address

30 REVERE BEACH PKWY APT 313
MEDFORD MA
02155-5162
US

V. Phone/Fax

Practice location:
  • Phone: 617-475-0190
  • Fax:
Mailing address:
  • Phone: 617-631-7380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE KIM
Title or Position: OWNER
Credential: DMD
Phone: 617-631-7380