OrganizationActive
East Tennessee Oral & Maxillofacial Surgery, PC
NPI 1174624498 · Oral and Maxillofacial Surgery (Dentist) · Maryville, TN
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
Practice location
1505 E Lamar Alexander Pkwy
Maryville, TN 37804-5131
Phone: (865) 983-8630
Fax: (865) 981-4914
Approximate (ZIP-level) locationGet directions
Mailing address
1505 E Lamar Alexander Pkwy
Maryville, TN 37804-5131
Registry dates
- Enumerated
- 2006-09-26
- Last updated
- 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.