NPIMap

Organization Active NPI

Zacko & Shatluch LTD

  • General Practice Dentistry
  • Reston, VA
National Provider Identifier
1356401822
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ZACKO & SHATLUCH LTD
Practice address
1712 Clubhouse Road
Suite 106
Reston, VA 20190
Phone
(703) 471-6600
Fax
(703) 471-1675
NPI assigned
Dec 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. George Bernard Zacko, DDSNPI 1073686499
Title
Owner Dentist
Phone
(703) 471-6600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1712 Clubhouse Road
Suite 106
Reston, VA 20190

Mailing address

1712 Clubhouse Road
Suite 106
Reston, VA 20190
Phone (703) 471-6600

National Provider Directory

National Provider Directory

Locations

1712 Clubhouse Rd
Ste 106
Reston, VA 20190
Phone (703) 471-6600

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356401822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1712 CLUBHOUSE ROAD",
            "address_2": "SUITE 106",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "20190",
            "telephone_number": "703-471-6600",
            "fax_number": "703-471-1675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1712 CLUBHOUSE ROAD",
            "address_2": "SUITE 106",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "20190",
            "telephone_number": "703-471-6600",
            "fax_number": "703-471-1675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ZACKO & SHATLUCH LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ZACKO",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "BERNARD",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "703-471-6600",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reston, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.