East Tennessee Oral & Maxillofacial Surgery, PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

4711 Issued in TN

Legal business name

EAST TENNESSEE ORAL & MAXILLOFACIAL SURGERY, PC

Practice address

1112 Medical Park CT
Sevierville, TN 37862-6933

Phone

(865) 453-1070

Fax

(865) 908-6190

NPI assigned

Oct 12, 2010

Last updated

Nov 18, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark M Widloski, DDSNPI 1285631135

Title

Owner

Phone

(865) 983-8630

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark M. Widloski, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Maryville, TN
  • NPI 1285631135
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1286841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290038400000",
    "number": "1043520042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 E LAMAR ALEXANDER PKWY",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378045131",
            "telephone_number": "865-983-8630",
            "fax_number": "865-981-4914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1112 MEDICAL PARK CT",
            "city": "SEVIERVILLE",
            "state": "TN",
            "postal_code": "378626933",
            "telephone_number": "865-453-1070",
            "fax_number": "865-908-6190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TENNESSEE ORAL & MAXILLOFACIAL SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-12",
        "last_updated": "2010-11-18",
        "status": "A",
        "authorized_official_last_name": "WIDLOSKI",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "865-983-8630",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "4711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Dudek
• Mary Frances Dukes, MD
• Sonia Mohanlal Dularam, M.S.
• Bradley Leroy Dyer, D.D.S.
• East Tennessee Children's Primary Care Center, Inc. (Dolly Parton Children's Hospital Sevierville Pediatrics)
• East TN Family Care LLC
• Elizabeth Joy Easton, MS
• Eddies Drug Store LLC (Eddie's Drug Store)
• Lauren Michelle Edmond, DO
• Joby R. Edmonds, CRNA

• Oral and Maxillofacial Surgery (Dentist) in Sevierville, TN
• Providers in Sevierville, TN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.