Provider Demographics
NPI:1255513933
Name:SKIOURIS, JOHN KYRIAKOS (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KYRIAKOS
Last Name:SKIOURIS
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 1:2630 E 7TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204
Mailing Address - Country:US
Mailing Address - Phone:704-335-0611
Mailing Address - Fax:704-335-0511
Practice Address - Street 1:2630 E 7TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204
Practice Address - Country:US
Practice Address - Phone:704-335-0611
Practice Address - Fax:704-335-0511
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5636122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997784Medicaid