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Organization
EAST TENNESSEE ORAL & MAXILLOFACIAL SURGERY, PC
Active
Organization
EAST TENNESSEE ORAL & MAXILLOFACIAL SURGERY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK M. WIDLOSKI DDS (OWNER/SURGEON)
(865) 983-8630
Entity
Organization
Contact information
Practice address
1505 E LAMAR ALEXANDER PKWY, MARYVILLE, TN 37804-5131
(865) 983-8630
(865) 981-4914
Mailing address
1505 E LAMAR ALEXANDER PKWY, MARYVILLE, TN 37804-5131
(865) 983-8630
(865) 981-4914
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS1794
TN
Other
Enumeration date
09/26/2006
Last updated
11/18/2010
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