Provider Demographics
NPI:1417963232
Name:CARAVAS, JERRY G JR (DDS)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:G
Last Name:CARAVAS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 LYNNHAVEN PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7430
Mailing Address - Country:US
Mailing Address - Phone:757-471-6020
Mailing Address - Fax:757-471-5205
Practice Address - Street 1:307 LYNNHAVEN PKWY STE 101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7430
Practice Address - Country:US
Practice Address - Phone:757-471-6020
Practice Address - Fax:757-471-5205
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006102122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9178692Medicaid