Mark M. Widloski, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DS4711 Issued in TN

Practice address

1505 E Lamar Alexander Pkwy
Maryville, TN 37804-5131

Phone

(865) 983-8630

Fax

(865) 983-3616

NPI assigned

Jul 7, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Maxillofacial SurgeryAlso: Oral Surgery

Education

Medical College of Wisconsin, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

East Tennessee Oral and Maxillofacial Surgery, PCGroup PAC ID 9234103359, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• East Tennessee Oral & Maxillofacial Surgery, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Maryville, TN
  • NPI 1174624498
  Medicare reassignment Care Compare group NPD Authorized official
• East Tennessee Oral & Maxillofacial Surgery, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Morristown, TN
  • NPI 1942510946
  NPD Authorized official

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318204800000",
    "number": "1285631135",
    "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": "865-983-3616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 E LAMAR ALEXANDER PKWY",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378045131",
            "telephone_number": "865-983-8630",
            "fax_number": "865-983-3616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDLOSKI",
        "first_name": "MARK",
        "middle_name": "M.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2011-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "DS4711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3225440",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deena L White, P.T.
• Kara Michelle White, FNP
• Sheila Gail White, APN
• Caitlin Reeves Whitehead, PTA
• Kristina Michelle Whitson, FNP-BC
• Hollie Wilder, BS
• William R Pedersen
• Charles Richard Williams, DC
• Crystal Christine Williams, APN
• Jesse Williams

• Oral and Maxillofacial Surgery (Dentist) in Maryville, TN
• Providers in Maryville, 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 Oct 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.