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

1551 E Morris Blvd
Morristown, TN 37813-5729

Phone

(423) 587-8383

Fax

(423) 587-8382

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 5

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
  NPD Authorized official
• Brock D. Evans, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Maryville, TN
  • NPI 1073785010
  NPD
• William Russell May Jr., DMD, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Cleveland, TN
  • NPI 1578798666
  NPD
• Troy A Trondson, DDS, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Maryville, TN
  • NPI 1093925497
  NPD
• Gregory A Conner, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Charlottesville, VA
  • NPI 1083785091
  NPD

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": "1942510946",
    "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": "1551 E MORRIS BLVD",
            "city": "MORRISTOWN",
            "state": "TN",
            "postal_code": "378135729",
            "telephone_number": "423-587-8383",
            "fax_number": "423-587-8382"
        }
    ],
    "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": []
}

• Leslie Denise Dyer, RN
• E. TN OB-GYN P.C.
• East Tennessee Center for Orthopaedic Excellence PLLC
• East Tennessee Clinic Corp
• East Tennessee Comprehensive Rehabilitation Center Inc
• East Tennessee Pathology, PLLC
• East Tennessee Vascular Center, PLLC
• East TN Pharmacist Consultants
• Terry Ann Eckert
• Meirav Edlis Matityahou

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