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Samuel Tack
Oral and Maxillofacial Surgery (Dentist) in Richmond, Virginia
NPI 1033658406

Samuel Tack is a Oral and Maxillofacial Surgery (Dentist) based in Richmond, VA and is specialized in Oral and Maxillofacial Surgery. Samuel Tack practices in Richmond, VA. The NPI Number for Samuel Tack is 1033658406 and holds a License No. 0401415733 (Virginia).

The current practice location address for Samuel Tack is 520 N 12Th St, Richmond, VA and can be reached out via phone at 804-628-7146.

Location: 520 N 12Th St, Richmond, VA, 23298-5064
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1033658406
Provider Name
Samuel Tack
Credential
Provider Entity Type
Individual
Gender
Male
Address
520 N 12Th St, Richmond, VA, 23298-5064
Phone Number
804-628-7146
Fax Number
Provider Enumeration Date
02/18/2017
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
520 N 12Th St
City
Richmond
State
Virginia
Zip
23298-5064
Phone Number
804-628-7146
Fax Number
person
Provider Business Mailing Address Details
Address
520 N 12Th St
City
Richmond
State
Virginia
Zip
23298-5064
Phone Number
804-628-7146
Fax Number
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Oral and Maxillofacial Surgery
Taxonomy
1223S0112X
License No.
0438000489 (Virginia)
Definition
The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
0401415733 (Virginia)
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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