NPIMap

Organization Active NPI

Jack Mavromatis DDS, LTD.

  • General Practice Dentistry
  • Virginia Beach, VA
National Provider Identifier
1134273683
Registry record updated Apr 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
JACK MAVROMATIS DDS, LTD.
Practice address
2248 Sunstates CT Ste 103
Virginia Beach, VA 23451-1553
Phone
(757) 496-9123
Fax
(757) 496-2083
NPI assigned
Jan 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jack Mavromatis Jr., DDSNPI 1508124462
Title
Owner Dentist
Phone
(757) 496-9123

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

2248 Sunstates CT Ste 103
Virginia Beach, VA 23451-1553

Mailing address

2248 Sunstates CT Ste 103
Virginia Beach, VA 23451-1553
Phone (757) 496-9123

National Provider Directory

National Provider Directory
Tax ID family
A Division of Atlantic Dental Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335744000000",
    "number": "1134273683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2248 SUNSTATES CT STE 103",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234511553",
            "telephone_number": "757-496-9123",
            "fax_number": "757-496-2083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2248 SUNSTATES CT STE 103",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234511553",
            "telephone_number": "757-496-9123",
            "fax_number": "757-496-2083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK MAVROMATIS DDS, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2012-04-30",
        "status": "A",
        "authorized_official_last_name": "MAVROMATIS",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "757-496-9123",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.