OrganizationActive
East Tennessee Oral & Maxillofacial Surgery, PC
NPI 1306156302 · Oral and Maxillofacial Surgery (Dentist) · Oak Ridge, TN
Provider details
- NPI number
- 1306156302
- Entity type
- Organization
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)Dental Providers
- Authorized official
- Mark Widloski, Owner
- License
- 4711 (TN)
Practice location
700 S Illinois Ave
Bldg A, Suite 104
Oak Ridge, TN 37830-7900
Phone: (865) 482-2600
Fax: (865) 482-2636
Mailing address
1505 E Lamar Alexander Pkwy
Maryville, TN 37804-5131
Registry dates
- Enumerated
- 2010-10-12
- 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.