Organization
EAST TENNESSEE ORAL & MAXILLOFACIAL SURGERY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK M WIDLOSKI DDS (OWNER)
(865) 983-8630
Entity
Organization
Contact information
Practice address
703 K ST, GREENEVILLE, TN 37745-6246
(423) 639-6769
(423) 638-3635
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
4711
TN
Other
Enumeration date
10/12/2010
Last updated
11/18/2010
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