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EAST TENNESSEE ORAL & MAXILLOFACIAL SURGERY, PC
NPI 1306156302
Dentist - Oral and Maxillofacial Surgery in Oak Ridge, TN

Active since October 12, 2010
700 S ILLINOIS AVE, BLDG A, SUITE 104, OAK RIDGE, TN 37830(865) 482-2600(865) 482-2636 Get Directions Write a Review

NPPES record last updated: November 18, 2010. Verified against the NPPES registry weekly; last sync: August 02, 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 1306156302) is a healthcare organization registered as an oral and maxillofacial surgery in Oak Ridge, Tennessee and active in the NPI registry since October 2010. The organization lists Mark M Widloski, Owner, as its authorized official.

NPPES Registry Identity

NPI1306156302
Entity TypeOrganization
Primary Taxonomy1223S0112X
Legal Business NameEAST TENNESSEE ORAL & MAXILLOFACIAL SURGERY, PC
Location Address700 S ILLINOIS AVE, BLDG A, SUITE 104Oak Ridge, TN 37830-7900
Mailing Address1505 E Lamar Alexander PkwyMaryville, TN 37804-5131 · (865) 983-8630 · Fax (865) 981-4914
Phone(865) 482-2600
Fax(865) 482-2636
Organization SubpartNo
Authorized OfficialMark M WidloskiOwner · (865) 983-8630
Enumeration DateOctober 12, 2010
Last NPPES UpdateNovember 18, 2010
✔ NPI 1306156302 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 · 4711
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.
700 S ILLINOIS AVE, Oak Ridge, TN 37830
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Other Identifiers 2

Medicare NSC6452150006TN
Medicare PIN3205757TN

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

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 1306156302. It was assigned to this organization in the NPPES registry on October 12, 2010.

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

East Tennessee Oral & Maxillofacial Surgery, PC is located at 700 S Illinois Ave Bldg A, Suite 104, Oak Ridge, TN 37830. The listed phone number is (865) 482-2600.

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.

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.