Individual
JACK MAVROMATIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2248 SUNSTATES CT, SUITE 103, VIRGINIA BEACH, VA 23451-1553
(757) 496-9123
(757) 496-2083
Mailing address
2248 SUNSTATES CT, SUITE 103, VIRGINIA BEACH, VA 23451-1553
(757) 496-9123
(757) 496-2083
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401006411
VA
Other
Enumeration date
04/30/2012
Last updated
04/30/2012
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