Active NPI
Athas Nicholas Kometas, DMD
- General Practice Dentistry
- Daytona Beach Shores, FL
National Provider Identifier
1063663722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN11431
- Practice address
- 3162 S Atlantic Ave
Suite C
Daytona Beach Shores, FL 32118-6286 - Phone
- (386) 760-0030
- Fax
- (386) 788-3873
- NPI assigned
- Sep 30, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN11431 | FL | Primary |
Addresses
Primary practice location
3162 S Atlantic Ave
Suite C
Daytona Beach Shores, FL 32118-6286
Mailing address
3162 S Atlantic Ave
Suite C
Daytona Beach Shores, FL 32118-6286
Phone (386) 760-0030
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 4, 2022 through Oct 4, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN11431 | FL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222732800000",
"number": "1063663722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3162 S ATLANTIC AVE",
"address_2": "SUITE C",
"city": "DAYTONA BEACH SHORES",
"state": "FL",
"postal_code": "321186286",
"telephone_number": "386-760-0030",
"fax_number": "386-788-3873"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3162 S ATLANTIC AVE",
"address_2": "SUITE C",
"city": "DAYTONA BEACH SHORES",
"state": "FL",
"postal_code": "321186286",
"telephone_number": "386-760-0030",
"fax_number": "386-788-3873"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOMETAS",
"first_name": "ATHAS",
"middle_name": "NICHOLAS",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-09-30",
"last_updated": "2008-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "DN11431",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Daytona Beach Shores, FL
- Dolores Slavin Holleman, CME
- Inner Riches Osteopathic Medical Associates Inc
- Tara James, FNP
- Joanne Eash Chiropractic LLC (Daytona Beach Shores Chiropractic)
- Deborah Arlt Klug
- Lake Diabetes Supply, Inc
- Lisa M Libby, RPH
- Jessica W. Macginnis, BCBA
- Marcella Scaccia Physician PLLC (Total Wellness & Healthy Aging)
- Marina Dental Center Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.