# JACK MAVROMATIS DDS, LTD.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134273683
- **Authorized official:** JACK MAVROMATIS JR. DDS (OWNER DENTIST)
- **Authorized official phone:** (757) 496-9123

## Contact information

- **Practice address:** 2248 SUNSTATES CT STE 103, VIRGINIA BEACH, VA 23451-1553
- **Practice address phone:** (757) 496-9123
- **Practice address fax:** (757) 496-2083
- **Mailing address:** 2248 SUNSTATES CT STE 103, VIRGINIA BEACH, VA 23451-1553
- **Mailing address phone:** (757) 496-9123
- **Mailing address fax:** (757) 496-2083

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 01/22/2007
- **Last updated:** 04/30/2012