Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Samuel Tack

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1033658406

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
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Practice location Address checks out

520 N 12th St
Richmond, VA 23298-5064
Phone: (804) 628-7146
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

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 number1033658406
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedFebruary 18, 2017
Last updated in NPPESSeptember 11, 2023
Certification dateSeptember 11, 2023
Mailing address520 N 12th St, Richmond, VA 23298-5064

Other providers in Richmond