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

700 S Illinois Ave
BLDG a, Suite 104
Oak Ridge, TN 37830-7900

Phone

(865) 482-2600

Fax

(865) 482-2636

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": "1306156302",
    "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": "700 S ILLINOIS AVE",
            "address_2": "BLDG A, SUITE 104",
            "city": "OAK RIDGE",
            "state": "TN",
            "postal_code": "378307900",
            "telephone_number": "865-482-2600",
            "fax_number": "865-482-2636"
        }
    ],
    "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": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "4711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Ann Dymond, PAC
• Hailey Eason, LPC/MHSP
• East Tennessee Children's Primary Care Center, Inc. (Dolly Parton Children's Hospital Oak Ridge Pediatrics)
• East Tennessee Ear, Nose & Throat Specialists, PC
• East Tennessee Family Dentistry, LLC
• East Tennessee Orthodontics
• East Tennessee Pediatric Dentistry at Oak Ridgepllc.
• East Tennessee Pulmonary Associates PC
• Joseph Bruce Eatherly, M.D.
• Jeri B Echols, LPN

• Oral and Maxillofacial Surgery (Dentist) in Oak Ridge, TN
• Providers in Oak Ridge, 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.