Individual
MICHELLE KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
55 SACK BLVD, LEOMINSTER, MA 01453-3325
(978) 466-6800
Mailing address
2216 IVY RD STE 205, CHARLOTTESVILLE, VA 22903-4966
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401415127
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/13/2014
Last updated
04/01/2025
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