Organization
EAST TENNESSEE ORAL AND 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
161 CAPITAL DRIVE, SUITE102, KNOXVILLE, TN 37922-3357
(865) 531-3909
(865) 539-0022
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
10/06/2010
Last updated
11/29/2010
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