Provider Demographics
NPI:1053427633
Name:WASILKO, THOMAS J (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:WASILKO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:J
Other - Last Name:WASILKO
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:DDS PC
Mailing Address - Street 1:633 LONG RUN RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15132
Mailing Address - Country:US
Mailing Address - Phone:412-751-7466
Mailing Address - Fax:412-751-7509
Practice Address - Street 1:633 LONG RUN RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132
Practice Address - Country:US
Practice Address - Phone:412-751-7466
Practice Address - Fax:412-751-7509
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023010L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist