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NPI Code Detail

MEDICARE: DR. CONNOR WASYLUCHA DDS

MEDICARE: DR. CONNOR WASYLUCHA DDS
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
1122300000XDentist12681TN

General Provider Information

NPI Number : 1831827914
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CONNOR WASYLUCHA DDS
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 :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2022
Last Update Date : 02/13/2026

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Directions to “ DR. CONNOR WASYLUCHA DDS” Practice Location

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