Provider Demographics
NPI:1639738321
Name:DEVINE, KIMIA (DMD)
Entity Type:Individual
Prefix:
First Name:KIMIA
Middle Name:
Last Name:DEVINE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 CAVENDISH DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4649
Mailing Address - Country:US
Mailing Address - Phone:317-833-5438
Mailing Address - Fax:
Practice Address - Street 1:1537 S SCATTERFIELD RD STE A
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-5783
Practice Address - Country:US
Practice Address - Phone:765-649-4995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice