Provider Demographics
NPI:1568127017
Name:WASYLYK, NIKOLAS MARK (DMD)
Entity Type:Individual
Prefix:DR
First Name:NIKOLAS
Middle Name:MARK
Last Name:WASYLYK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:715 SANSOM ST APT 4F
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3320
Mailing Address - Country:US
Mailing Address - Phone:484-763-0747
Mailing Address - Fax:
Practice Address - Street 1:550 UNIVERSITY BLVD # UH3145
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:215-955-6215
Practice Address - Fax:215-923-9189
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS0434241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery