# ZACKO & SHATLUCH LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356401822
- **Authorized official:** MR. GEORGE BERNARD ZACKO DDS (OWNER DENTIST)
- **Authorized official phone:** (703) 471-6600

## Contact information

- **Practice address:** 1712 CLUBHOUSE ROAD, SUITE 106, RESTON, VA 20190
- **Practice address phone:** (703) 471-6600
- **Practice address fax:** (703) 471-1675
- **Mailing address:** 1712 CLUBHOUSE ROAD, SUITE 106, RESTON, VA 20190
- **Mailing address phone:** (703) 471-6600
- **Mailing address fax:** (703) 471-1675

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 12/12/2006
- **Last updated:** 08/22/2020