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EAST TENNESSEE ORAL & MAXILLOFACIAL SURGERY, PC
NPI 1174624498
Dentist - Oral and Maxillofacial Surgery in Maryville, TN

Active since September 26, 2006
4/5
Overall Rating
1505 E LAMAR ALEXANDER PKWY, MARYVILLE, TN 37804(865) 983-8630(865) 981-4914 Get Directions Write a Review

NPPES record last updated: November 18, 2010. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About East Tennessee Oral & Maxillofacial Surgery, Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EAST TENNESSEE ORAL & MAXILLOFACIAL SURGERY, PC (NPI 1174624498) is a healthcare organization registered as an oral and maxillofacial surgery in Maryville, Tennessee and active in the NPI registry since September 2006. The organization lists Mark M. Widloski, Owner/surgeon, as its authorized official.

NPPES Registry Identity

NPI1174624498
Entity TypeOrganization
Primary Taxonomy1223S0112X
Legal Business NameEAST TENNESSEE ORAL & MAXILLOFACIAL SURGERY, PC
Location Address1505 E LAMAR ALEXANDER PKWYMaryville, TN 37804-5131
Mailing Address1505 E Lamar Alexander PkwyMaryville, TN 37804-5131 · (865) 983-8630 · Fax (865) 981-4914
Phone(865) 983-8630
Fax(865) 981-4914
Organization SubpartNo
Authorized OfficialMark M. WidloskiOwner/surgeon · (865) 983-8630
Enumeration DateSeptember 26, 2006
Last NPPES UpdateNovember 18, 2010
✔ NPI 1174624498 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
License✔ Licensed in TN · DS1794
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
1505 E LAMAR ALEXANDER PKWY, Maryville, TN 37804
Open in Google Maps ↗

Other Identifiers 3

Medicare NSC6452150002TN
Medicare PIN3205757TN
Medicaid3205757TN

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

East Tennessee Oral & Maxillofacial Surgery, Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

5

Medicare enrollment records show 5 clinicians reassign Medicare billing to East Tennessee Oral & Maxillofacial Surgery, PC, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.

Clinicians, nearest first (5)

Mark Widloski, DDS
Maxillofacial Surgery
NPI 1285631135
1505 E LAMAR ALEXANDER PKWY
Maryville, TN 37804
(865) 983-8630
✔ PECOS✔ Accepts MedicareSame address
Brock Evans, DMD
Maxillofacial Surgery
NPI 1073785010
1505 E LAMAR ALEXANDER PKWY
Maryville, TN 37804
(865) 983-8630
✔ PECOS✔ Accepts MedicareSame address
Troy Trondson, DDS, MD
Maxillofacial Surgery
NPI 1093925497
1505 E LAMAR ALEXANDER PKWY
Maryville, TN 37804
(865) 983-8630
✔ PECOS✔ Accepts MedicareSame address
William May, DMD, MD
Maxillofacial Surgery
NPI 1578798666
2253 CHAMBLISS AVE NW SUITE 403
Cleveland, TN 37311
(423) 709-0400
✔ PECOS✔ Accepts Medicare65 mi
Gregory Conner, DDS
Oral Surgery
NPI 1083785091
244 HYDRAULIC RIDGE ROAD
Charlottesville, VA 22901
(434) 973-3348
✔ PECOS✔ Accepts Medicare342 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Nursing Home Quality Ratings CMS Care Compare

Quality ratings, staffing and inspection history for Ocoee Transitional Care Center LLC (CMS certification number 445404), from CMS Care Compare.

Ocoee Transitional Care Center LLC

Nursing home · Maryville, TN
4/5 CMS Overall Rating
OwnershipNon profit - Corporation
CMS Certification Number445404
Certified Beds76 beds69 residents per day on average
Medicare & Medicaid Participant SinceOctober 3, 1997
Resident & Family CouncilResident council
Hospital-based Automatic sprinkler system

CMS Star Ratings

Quality Measures
Based on a select set of clinical quality measures.
5/5
Long-Stay Quality
Quality of care delivered to long-term residents.
5/5
Short-Stay Quality
Quality of care delivered to short-term and rehabilitation residents.
5/5
Staffing
Based on nursing staff hours relative to resident needs.
2/5
Weighted Health Inspection Score
Lower scores are better; the score summarizes deficiencies found on recent inspections.
32
Ratings are assigned by CMS on a one-to-five star scale; five is the highest. Categories without a current CMS rating are not shown.

Staffing & Turnover

Total Nurse Staffing
nurse aide 1.57 · LPN 1.77 · RN 1.23
4.57 hrs per resident per day
Weekend Nurse Staffing
3.96 hrs per resident per day
Physical Therapist Staffing
0.08 hrs per resident per day
Higher staffing hours generally allow more direct care time per resident.

Inspections & Enforcement

Facility-Reported Incidents
0
Substantiated Complaints
0
Fines
0
Medicare Payment Denials
0
Total Penalties
0
Counts come from CMS inspections and complaint investigations over approximately the past three years. CMS Care Compare data as of October 1, 2024.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is East Tennessee Oral & Maxillofacial Surgery, PC's NPI number?

The NPI number for East Tennessee Oral & Maxillofacial Surgery, PC is 1174624498. It was assigned to this organization in the NPPES registry on September 26, 2006.

Where is East Tennessee Oral & Maxillofacial Surgery, PC located?

East Tennessee Oral & Maxillofacial Surgery, PC is located at 1505 E Lamar Alexander Pkwy, Maryville, TN 37804. The listed phone number is (865) 983-8630.

What is East Tennessee Oral & Maxillofacial Surgery, PC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is East Tennessee Oral & Maxillofacial Surgery, PC enrolled in Medicare?

Yes. East Tennessee Oral & Maxillofacial Surgery, PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through East Tennessee Oral & Maxillofacial Surgery, PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians in 2 Medicare specialties reassign their Medicare billing to East Tennessee Oral & Maxillofacial Surgery, PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Maxillofacial Surgery (4) and Oral Surgery (1). Of these, 3 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Is East Tennessee Oral & Maxillofacial Surgery, PC a Medicare-certified nursing home?

Yes. Ocoee Transitional Care Center LLC is a Medicare-certified nursing home with 76 certified beds.

What quality rating does East Tennessee Oral & Maxillofacial Surgery, PC have?

CMS rates Ocoee Transitional Care Center LLC 4 out of 5 stars overall on Care Compare. The full measure detail is in the Nursing Home Quality Ratings section above.

What insurance does East Tennessee Oral & Maxillofacial Surgery, PC accept?

Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee and 3 other insurers list East Tennessee Oral & Maxillofacial Surgery, PC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for East Tennessee Oral & Maxillofacial Surgery, PC was last updated on November 18, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.