Provider Demographics
NPI:1396864021
Name:GANDHI, KIM KISHIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:KISHIN
Last Name:GANDHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2247 PALM BEACH LAKES BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3470
Mailing Address - Country:US
Mailing Address - Phone:561-242-2861
Mailing Address - Fax:
Practice Address - Street 1:2247 PALM BEACH LAKES BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3470
Practice Address - Country:US
Practice Address - Phone:561-242-2861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL115921223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics