Provider Demographics
NPI:1326552522
Name:CONNOR, LUCAS BLAINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:BLAINE
Last Name:CONNOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 WHISPER COVE DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-7243
Mailing Address - Country:US
Mailing Address - Phone:563-260-1994
Mailing Address - Fax:
Practice Address - Street 1:3625 BRASELTON HWY STE 101
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4696
Practice Address - Country:US
Practice Address - Phone:770-614-9467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0160151223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics