OrganizationActive
East Tennessee Oral and Maxillofacial Surgery, PC
NPI 1861701005 · Oral and Maxillofacial Surgery (Dentist) · Knoxville, TN
Provider details
- NPI number
- 1861701005
- Entity type
- Organization
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)Dental Providers
- Authorized official
- Mark Widloski, Owner
- License
- 4711 (TN)
Practice location
161 Capital Drive
Suite102
Knoxville, TN 37922-3357
Phone: (865) 531-3909
Fax: (865) 539-0022
Mailing address
1505 E Lamar Alexander Pkwy
Maryville, TN 37804-5131
Registry dates
- Enumerated
- 2010-10-06
- Last updated
- 2010-11-29
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.