MEDICARE: JERRY G CARAVAS, DDS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401006102	VA

General Provider Information

NPI Number	:	1386778900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JERRY G CARAVAS, DDS, PC

Provider Business Mailing Address
First Line	:	1539 AMBERLEY FOREST RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-4706
Country	:	US
Telephone Number	:	757-471-6020
Fax Number	:	757-471-5205

Provider Business Practice Location Address
First Line	:	1539 AMBERLEY FOREST RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-4706
Country	:	US
Telephone Number	:	757-471-6020
Fax Number	:	757-471-5205

Authorized Official
Title or Position	:	DENTIST OWNER
Name	:	JERRY G CARAVAS
Credential	:	DDS PRESIDENT
Telephone Number	:	757-471-6020

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	11/28/2011

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