East Tennessee Oral & Maxillofacial Surgery, PC
NPI 1174624498 · Oral and Maxillofacial Surgery (Dentist) · Maryville, TN
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
East Tennessee Oral & Maxillofacial Surgery, PC is a Oral and Maxillofacial Surgery (Dentist) organization in Maryville, TN (NPI 1174624498).
Provider details
- NPI number
- 1174624498
- Entity type
- Organization
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)Dental Providers
- Organization subpart
- No
- Authorized official
- Mark Widloski, Owner/Surgeon(865) 983-8630
- License
- DS1794 (TN)
Specialties & taxonomies
Dental Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2006-09-26
- Last updated
- 2010-11-18
Frequently asked questions
- What is East Tennessee Oral & Maxillofacial Surgery, PC's NPI number?
- East Tennessee Oral & Maxillofacial Surgery, PC's National Provider Identifier (NPI) is 1174624498, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is East Tennessee Oral & Maxillofacial Surgery, PC?
- East Tennessee Oral & Maxillofacial Surgery, PC is classified in the NPPES registry as Oral and Maxillofacial Surgery (Dentist) (Dental Providers).
- Where is East Tennessee Oral & Maxillofacial Surgery, PC located?
- East Tennessee Oral & Maxillofacial Surgery, PC's practice location on file with NPPES is 1505 E Lamar Alexander Pkwy, Maryville, TN 37804-5131.
- What is East Tennessee Oral & Maxillofacial Surgery, PC's phone number?
- The practice phone number listed in the NPPES registry for East Tennessee Oral & Maxillofacial Surgery, PC is (865) 983-8630.
- Does East Tennessee Oral & Maxillofacial Surgery, PC accept Medicare?
- East Tennessee Oral & Maxillofacial Surgery, PC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for East Tennessee Oral & Maxillofacial Surgery, PC?
- The authorized official listed on East Tennessee Oral & Maxillofacial Surgery, PC's NPPES record is Mark Widloski, Owner/Surgeon. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is East Tennessee Oral & Maxillofacial Surgery, PC's NPI active?
- Yes — East Tennessee Oral & Maxillofacial Surgery, PC's NPI (1174624498) is active in the NPPES registry as of the last update on 2010-11-18.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.