Samuel Tack
Samuel Tack is a Student in an Organized Health Care Education/Training Program in Richmond, Virginia. Practices as a sole proprietor and works from 2 locations. Licensed in Virginia.
- Licensed in
- VA
- In the registry since
- 2017
- Specialties on file
- 2
Practice location Address checks out
Richmond, VANo coordinates on file. Search this address in Google Maps
Additional practice locations (1)
- 27005 76th Ave, New Hyde Park, NY 11040-1402 — (718) 470-7000
Specialties & licences
| Oral and Maxillofacial Surgery (Dentist) (primary) | Taxonomy 1223S0112X · Licence 0438000489 (VA) |
|---|---|
| Student in an Organized Health Care Education/Training Program | Taxonomy 390200000X · Licence 0401415733 (VA) |
Record details
| NPI number | 1033658406 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | Yes |
| NPI enumerated | February 18, 2017 |
| Last updated in NPPES | September 11, 2023 |
| Certification date | September 11, 2023 |
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