NPIMap

Organization Active NPI

Jack Mavromatis, DDS, LTD.

Doing business as a division of Atlantic Dental Care

  • Dentist
  • Virginia Beach, VA
National Provider Identifier
1467798603
Registry record updated Dec 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0401006411 Issued in VA
Legal business name
JACK MAVROMATIS, DDS, LTD.
Doing business as
a division of Atlantic Dental Care
Practice address
2248 Sunstates CT Ste 103
Virginia Beach, VA 23451-1553
Phone
(757) 496-9123
Fax
(757) 496-2083
NPI assigned
Dec 17, 2012
Organization subpart
Yes
Parent organization
ATLANTIC DENTAL CARE, PLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 17, 2012

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

Authorized official

Name
Jack Mavromatis, DDSNPI 1508124462
Title
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
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 0401006411 VA 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

Other names 1

  • a division of Atlantic Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
A Division of Atlantic Dental Care2 organizations share this tax ID, including this one
Part of
Melvin E Cruser III DDS

Other organizations with this tax ID 1

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

Locations

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

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": "1355702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355702400000",
    "number": "1467798603",
    "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": "YES",
        "parent_organization_legal_business_name": "ATLANTIC DENTAL CARE, PLC",
        "enumeration_date": "2012-12-17",
        "last_updated": "2012-12-17",
        "status": "A",
        "authorized_official_last_name": "MAVROMATIS",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "757-496-9123",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401006411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "a division of Atlantic Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 17, 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.