# THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427163666
- **Authorized official:** DR. CHARLES EDWARD WITKOWSKI DDS (OWNER)
- **Authorized official phone:** (423) 283-4555

## Contact information

- **Practice address:** 1021 W OAKLAND AVE, SUITE 109, JOHNSON CITY, TN 37604-2191
- **Practice address phone:** (423) 283-4555
- **Practice address fax:** (423) 283-3044
- **Mailing address:** 1021 W OAKLAND AVE, SUITE 109, JOHNSON CITY, TN 37604-2191
- **Mailing address phone:** (423) 283-4555
- **Mailing address fax:** (423) 283-3044

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DS004426 | TN | Yes |

## Other

- **Enumeration date:** 08/20/2006
- **Last updated:** 08/22/2020