MARK M. WIDLOSKI DDS
NPI 1285631135
Dentist - Oral and Maxillofacial Surgery in Maryville, TN

Q: What is Mark Widloski's NPI number?

The NPI number for Mark Widloski is 1285631135. It was assigned to this individual provider in the NPPES registry on July 7, 2005.

Q: What is Mark Widloski's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Mark Widloski was last updated on October 10, 2011. 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.

Active since July 07, 2005PECOS EnrolledAccepts Medicare Assignment

1505 E LAMAR ALEXANDER PKWY, MARYVILLE, TN 37804(865) 983-8630(865) 983-3616 Get Directions Write a Review

NPPES record last updated: October 10, 2011. Verified against the NPPES registry weekly; last sync: October 18, 2026.

On this page

About Mark M. Widloski Dds NPPES

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

MARK M. WIDLOSKI DDS (NPI 1285631135) is an individual oral and maxillofacial surgery provider in Maryville, Tennessee, licensed in Tennessee (DS4711) and active in the NPI registry since July 2005. He is enrolled in Medicare PECOS and is a graduate of Medical College Of Wisconsin (1986).

NPPES Registry Identity

NPI1285631135

Entity TypeIndividualMale

Primary Taxonomy1223S0112X

Provider Legal NameMARK M. WIDLOSKICredential: DDS

Location Address1505 E LAMAR ALEXANDER PKWYMaryville, TN 37804-5131

Mailing Address1505 E Lamar Alexander PkwyMaryville, TN 37804-5131 · (865) 983-8630 · Fax (865) 983-3616

Phone(865) 983-8630

Fax(865) 983-3616

Sole ProprietorNo

Medical School CMSMedical College Of WisconsinGraduated 1986

Enumeration DateJuly 7, 2005

Last NPPES UpdateOctober 10, 2011

✔ NPI 1285631135 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 · DS4711

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

Medicaid3225440TN

Medicare UPINT74436TN

Medicare ID-Type Unspecified3225440TN

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, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mark M. Widloski Dds is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4981733391

PECOS Enrollment IDI20100525000036

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Mark Widloski reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

East Tennessee Oral & Maxillofacial Surgery, PC

Same address

Oral and Maxillofacial Surgery

1505 E LAMAR ALEXANDER PKWY
Maryville, TN 37804

Reassigned Medicare billing, Tennessee enrollment
5 clinicians in this Medicare group

NPI 1174624498 (865) 983-8630

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

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

New patient office or other outpatient visit with straightforward medical decision making, if using time, 15 minutes or more 99202

This service involves an initial visit to the doctor's office or other outpatient setting. It typically lasts between 15-29 minutes. The doctor will review your medical history, conduct a physical examination, and discuss your health concerns. It's a chance to establish your health baseline and address any immediate medical issues.

16 services16 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 37804 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$81.53 typical visit price

range $52.64 – $160.89

Typical copayment $20.38 (range $13.16 – $40.22)

Most-billed visit code 99203

Established Patient

$66.01 typical visit price

range $16.72 – $131.41

Typical copayment $16.50 (range $4.18 – $32.85)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. BROCK D. EVANS DMD

Dentist (Oral and Maxillofacial Surgery)