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SAMUEL TACK
NPI 1033658406
Dentist - Oral and Maxillofacial Surgery in Richmond, VA

Active since February 18, 2017PECOS Enrolled
520 N 12TH ST, RICHMOND, VA 23298(804) 628-7146 Get Directions Write a Review

NPPES record last updated: September 11, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jan 15, 2018, Feb 18, 2017 (2 updates tracked since 2017).

About Samuel Tack NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAMUEL TACK (NPI 1033658406) is an individual oral and maxillofacial surgery provider in Richmond, Virginia, licensed in Virginia (0438000489) and active in the NPI registry since February 2017. He is enrolled in Medicare PECOS and maintains a secondary practice location in New Hyde Park.

NPPES Registry Identity

NPI1033658406
Entity TypeIndividualMale
Primary Taxonomy1223S0112X
Provider Legal NameSAMUEL TACK
Location Address520 N 12TH STRichmond, VA 23298-5064
Mailing Address520 N 12th StRichmond, VA 23298-5064 · (804) 628-7146
Phone(804) 628-7146
Sole ProprietorYes
Enumeration DateFebruary 18, 2017
Last NPPES UpdateSeptember 11, 20232 updates tracked since enumeration
NPPES CertifiedSeptember 11, 2023
✔ NPI 1033658406 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
License✔ Licensed in VA · 0438000489
Definition

An oral and maxillofacial surgery dentist specialized in 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.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X · License 0401415733 (VA)
520 N 12TH ST, Richmond, VA 23298
Open in Google Maps ↗

Secondary Practice Location 1

Location 127005 76th AveNew Hyde Park, NY 11040-1402 · Phone (718) 470-7000

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Florida Combined Life, Humana and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samuel Tack is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 23298 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$86.88 typical visit price
range $56.19 – $170.30
Typical copayment $21.72 (range $14.04 – $42.57)
Most-billed visit code 99203
Established Patient
$70.08 typical visit price
range $18.07 – $138.91
Typical copayment $17.52 (range $4.51 – $34.72)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. LAURIE CHILDS CARTER D.D.S.
Dentist
520 N 12TH ST, 315 LYONS BLDG.
RICHMOND, VA 23298
Richmond City (804) 828-1778
DR. BLAKE JEREMY MAXFIELD DDS
Dentist (Orthodontics and Dentofacial Orthopedics)
520 N 12TH ST
RICHMOND, VA 23298
Richmond City (804) 828-0843
DR. ALFRED JOSEPH CERTOSIMO
Dentist (General Practice)
520 N 12TH ST, P.O. 980566
RICHMOND, VA 23298
Richmond City (804) 828-9190
DR. MICHAEL HEALY DDS
Dentist (General Practice)
520 N 12TH ST
RICHMOND, VA 23298
Richmond City (804) 828-9196
DR. BRIDGET ELLEN BYRNE DDS
Dentist (Endodontics)
520 N 12TH ST, DEAN'S OFFICE ROOM 450
RICHMOND, VA 23298
Richmond City (804) 828-9184
FAWAZ AL-FORAIH DDS
Dentist (Endodontics)
520 N 12TH ST, LYONS BLDG, RM 224
RICHMOND, VA 23298
Richmond City (804) 263-7197
MANPREET S SARAO B.D.S., D.D.S.
Dentist (General Practice)
520 N 12TH ST
RICHMOND, VA 23298
Richmond City (804) 828-0784
RICHARD ANDREW HUTCHISON
Student in an Organized Health Care Education/Training Program
520 N 12TH ST
RICHMOND, VA 23298
Richmond City (804) 828-8529

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Samuel Tack's NPI number?

The NPI number for Samuel Tack is 1033658406. It was assigned to this individual provider in the NPPES registry on February 18, 2017.

Where is Samuel Tack located?

Samuel Tack practices at 520 N 12th St, Richmond, VA 23298. The listed phone number is (804) 628-7146.

What is Samuel Tack's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is Samuel Tack enrolled in Medicare?

Yes. Samuel Tack is registered in the Medicare PECOS enrollment system.

What insurance does Samuel Tack accept?

Health plans from Anthem Blue Cross and Blue Shield, Florida Combined Life, Humana and UnitedHealthcare list Samuel Tack as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Samuel Tack was last updated on September 11, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.