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NPI Code Detail

MEDICARE: MCMINN DENTAL CENTER PLLC

MEDICARE: MCMINN DENTAL CENTER PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1750233490
Entity Type Code : Organization
Provider Name (Legal Business Name) : MCMINN DENTAL CENTER PLLC
Provider Business Mailing Address
First Line : 800 W MADISON AVE
Second Line :
City : ATHENS
State : TN
Zip : 37303-3430
Country : US
Telephone Number : 423-745-5212
Fax Number :
Provider Business Practice Location Address
First Line : 800 W MADISON AVE
Second Line :
City : ATHENS
State : TN
Zip : 37303-3430
Country : US
Telephone Number : 423-745-5212
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. CONNOR WASYLUCHA
Credential : DDS
Telephone Number : 509-520-0618
Provider Enumeration Date : 02/13/2026
Last Update Date : 02/13/2026

Similar Medicare Providers

1831827914 — DR. CONNOR WASYLUCHA DDS
Practice Location Address:
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ATHENS, TN
37303-3430
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1003774902 — ALAN BROCK ESTATE
Practice Location Address:
800 W MADISON AVE
ATHENS, TN
37303-3430
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1093782930 — MRS. MICHELLE RUTH CRYE LPC
Practice Location Address:
506 RICHARDSON ST
ATHENS, TX
75751-3430
Practice Phone: 903-677-4800
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Directions to “MCMINN DENTAL CENTER PLLC ” Practice Location

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