Provider Demographics
NPI:1427246867
Name:DIVARIS, KIMON (DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:KIMON
Middle Name:
Last Name:DIVARIS
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNC SCHOOL OF DENTISTRY DEPT OF PEDIATRIC DENTISTRY
Mailing Address - Street 2:228 BRAUER HALL CB #7450
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7450
Mailing Address - Country:US
Mailing Address - Phone:919-537-3556
Mailing Address - Fax:919-537-3950
Practice Address - Street 1:UNC SCHOOL OF DENTISTRY DEPT OF PEDIATRIC DENTISTRY
Practice Address - Street 2:228 BRAUER HALL CB #7450
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7450
Practice Address - Country:US
Practice Address - Phone:919-537-3556
Practice Address - Fax:919-537-3950
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC126441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5921506Medicaid