Search › Virginia › 1223S0112X
Samuel Tack
NPI 1033658406 · on the registry since 2017 · sole proprietor
Practice
- Address
- 520 N 12th St
Richmond, VA 23298 - Phone
- (804) 628-7146
- Organisation at this address
- Vcu
Dentistry Vcu
Virginia Commonwealth University
Virginia Commonwealth University
Vcu Predoctoral Dental Services LlcInferred from a shared address, not stated in the registry. - Clinicians at this address
- 126
Additional practice sites
- 27005 76th Ave, New Hyde Park, NY
Registry record
- Primary taxonomy
- 1223S0112X
1223S0112X
- Also registered as
- 390200000X
- Licence states on file
- VA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2023-09-11
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Virginia