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EAST TENNESSEE ORAL & MAXILLOFACIAL SURGERY, PC
NPI 1497065494
Dentist - Oral and Maxillofacial Surgery in Cleveland, TN

Active since October 12, 2010
2253 CHAMBLISS AVE NW, SUITE 403, CLEVELAND, TN 37311(423) 709-0400(423) 709-0401 Get Directions Write a Review

NPPES record last updated: November 18, 2010. Verified against the NPPES registry weekly; last sync: August 09, 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 1497065494) is a healthcare organization registered as an oral and maxillofacial surgery in Cleveland, Tennessee and active in the NPI registry since October 2010. The organization lists Mark M Widloski, Owner, as its authorized official.

NPPES Registry Identity

NPI1497065494
Entity TypeOrganization
Primary Taxonomy1223S0112X
Legal Business NameEAST TENNESSEE ORAL & MAXILLOFACIAL SURGERY, PC
Location Address2253 CHAMBLISS AVE NW, SUITE 403Cleveland, TN 37311-3861
Mailing Address1505 E Lamar Alexander PkwyMaryville, TN 37804-5131 · (865) 983-8630 · Fax (865) 981-4914
Phone(423) 709-0400
Fax(423) 709-0401
Organization SubpartNo
Authorized OfficialMark M WidloskiOwner · (865) 983-8630
Enumeration DateOctober 12, 2010
Last NPPES UpdateNovember 18, 2010
✔ NPI 1497065494 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.
2253 CHAMBLISS AVE NW, Cleveland, TN 37311
Open in Google Maps ↗

Other Identifiers 2

Medicare NSC6452150005TN
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

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.

MISS MARGIE AMANDA COOK FNP
Nurse Practitioner
2253 CHAMBLISS AVE NW, SUITE 202
CLEVELAND, TN 37311
Bradley County (423) 472-3332
ASMA N KHATRI MD
Internal Medicine (Infectious Disease)
2253 CHAMBLISS AVE NW, STE 400
CLEVELAND, TN 37311
Bradley County (423) 664-5165
WILLIAM FRANK JOHNSON II MD
Surgery
2253 CHAMBLISS AVE NW, SUITE 100
CLEVELAND, TN 37311
Bradley County (423) 472-5423
WILLIAM RUSSELL MAY JR. DMD, MD
Dentist (Oral and Maxillofacial Surgery)
2253 CHAMBLISS AVE NW, SUITE 403
CLEVELAND, TN 37311
Bradley County (423) 709-0400
JAMES KENT HULVEY FNP
Nurse Practitioner (Family)
2253 CHAMBLISS AVE NW, SUITE 200
CLEVELAND, TN 37311
Bradley County (423) 339-2889

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 1497065494. 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 2253 Chambliss Ave NW Suite 403, Cleveland, TN 37311. The listed phone number is (423) 709-0400.

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.