Provider Demographics
NPI:1386778900
Name:JERRY G CARAVAS, DDS, PC
Entity type:Organization
Organization Name:JERRY G CARAVAS, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:CARAVAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PRESIDENT
Authorized Official - Phone:757-471-6020
Mailing Address - Street 1:1539 AMBERLEY FOREST RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-4706
Mailing Address - Country:US
Mailing Address - Phone:757-471-6020
Mailing Address - Fax:757-471-5205
Practice Address - Street 1:1539 AMBERLEY FOREST RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-4706
Practice Address - Country:US
Practice Address - Phone:757-471-6020
Practice Address - Fax:757-471-5205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006102122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty