Jack Mavromatis, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401006411 Issued in VA

Practice address

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

Phone

(757) 496-9123

Fax

(757) 496-2083

NPI assigned

Apr 30, 2012

Last updated

Apr 30, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jack Mavromatis DDS, LTD.

  • General Practice Dentistry
  • Virginia Beach, VA
  • NPI 1134273683
  NPD (past) Authorized official
• Jack Mavromatis, DDS, LTD.

  dba a division of Atlantic Dental Care

  • Dentist
  • Virginia Beach, VA
  • NPI 1467798603
  NPD (past) Authorized official

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

{
    "created_epoch": "1335744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335744000000",
    "number": "1508124462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2248 SUNSTATES CT",
            "address_2": "SUITE 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",
            "address_2": "SUITE 103",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234511553",
            "telephone_number": "757-496-9123",
            "fax_number": "757-496-2083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAVROMATIS",
        "first_name": "JACK",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-30",
        "last_updated": "2012-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401006411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Micheal Maugeri, LPTA
• Anne Kathryn Maurer, D.C.
• Caroline Davis Maurette
• Carter Jack Mavromatis, DMD
• Corey Mavromatis, DMD
• Komi Mawussi
• Maxim Healthcare Services
• Maxim Healthcare Services
• Maxim Healthcare Services Inc.
• Maxim Healthcare Services, Inc.

• General Practice Dentistry in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• General Practice Dentistry in Virginia

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.