Provider Demographics
NPI:1194802355
Name:HACK, MICHAEL A (DMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:HACK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 CALIFORNIA ST
Mailing Address - Street 2:SUITE #450
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-2602
Mailing Address - Country:US
Mailing Address - Phone:415-433-1970
Mailing Address - Fax:415-433-0469
Practice Address - Street 1:311 CALIFORNIA ST
Practice Address - Street 2:SUITE #450
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-2602
Practice Address - Country:US
Practice Address - Phone:415-433-1970
Practice Address - Fax:415-433-0469
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA218891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice