Provider Demographics
NPI:1356401822
Name:ZACKO & SHATLUCH LTD
Entity type:Organization
Organization Name:ZACKO & SHATLUCH LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:ZACKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-471-6600
Mailing Address - Street 1:1712 CLUBHOUSE ROAD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190
Mailing Address - Country:US
Mailing Address - Phone:703-471-6600
Mailing Address - Fax:703-471-1675
Practice Address - Street 1:1712 CLUBHOUSE ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190
Practice Address - Country:US
Practice Address - Phone:703-471-6600
Practice Address - Fax:703-471-1675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty