Healthcare Provider Details

I. General information

NPI: 1508283474
Provider Name (Legal Business Name): DR. JOHN SAECKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23185 FRONT STREET
ACCOMAC VA
23301
US

IV. Provider business mailing address

PO BOX 339
ACCOMAC VA
23301-0339
US

V. Phone/Fax

Practice location:
  • Phone: 757-787-4425
  • Fax: 757-787-8770
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401005489
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: