EAST TENNESSEE ORAL & MAXILLOFACIAL SURGERY, PC (NPI# 1033429030) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033429030 |
| Entity Type | Organization |
| Organization Name | EAST TENNESSEE ORAL & MAXILLOFACIAL SURGERY, PC |
| Practice Address |
703 K St Greeneville TN 37745-6246 |
| Mailing Address |
1505 E Lamar Alexander Pkwy Maryville TN 37804-5131 |
| Practice Telephone | 4236396769 |
| Practice Fax Number | 4236383635 |
| Mailing Telephone | 8659838630 |
| Mailing Fax Number | 8659814914 |
| Enumeration Date | 2010-10-12 |
| Last Update Date | 2010-11-18 |
| Authorized Official Name | DR. MARK M WIDLOSKI (OWNER) |
| Authorized Official Telephone | 8659838630 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
4711 | TN | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770893778 | East Tennessee Oral & Maxillofacial Surgery, PC | Dentist | 307 Maple St, Athens, TN 37303-2957 | 2010-10-12 |
| 1306156302 | East Tennessee Oral & Maxillofacial Surgery, PC | Dentist | 700 S Illinois Ave, Bldg A, Suite 104, Oak Ridge, TN 37830-7900 | 2010-10-12 |
| 1043520042 | East Tennessee Oral & Maxillofacial Surgery, PC | Dentist | 1112 Medical Park Ct, Sevierville, TN 37862-6933 | 2010-10-12 |
| 1225348220 | East Tennessee Oral & Maxillofacial Surgery, PC | Dentist | 2939 Essary Rd, Suite 1, Knoxville, TN 37918-2464 | 2010-10-12 |
| 1497065494 | East Tennessee Oral & Maxillofacial Surgery, PC | Dentist | 2253 Chambliss Ave Nw, Suite 403, Cleveland, TN 37311-3861 | 2010-10-12 |
| 1942510946 | East Tennessee Oral & Maxillofacial Surgery, PC | Dentist | 1551 E Morris Blvd, Morristown, TN 37813-5729 | 2010-10-12 |
| 1174624498 | East Tennessee Oral & Maxillofacial Surgery, PC | Dentist | 1505 E Lamar Alexander Pkwy, Maryville, TN 37804-5131 | 2006-09-26 |
| Street Address |
703 K ST |
| City | GREENEVILLE |
| State | TN |
| Zip Code | 37745-6246 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144667908 | Brad S. Johnson, Dmd, Pllc | Dentist | 703 K St, Greeneville, TN 37745-6246 | 2013-06-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619409489 | Watauga Recovery Center Greeneville | Family Medicine | 819 W Church Street, Greeneville, TN 37745 | 2017-03-31 |
| 1154862340 | Open Arms Care Corporation | Intermediate Care Facility, Mentally Retarded | 1404 East Church St, Greeneville, TN 37745 | 2017-03-20 |
| 1770024010 | Open Arms Care Corporation | Intermediate Care Facility, Mentally Retarded | 1406 East Church Street, Greeneville, TN 37745 | 2017-03-20 |
| 1336685569 | D&s Residential Services, Lp | Intermediate Care Facility, Mentally Retarded | 1010 Old Stage Rd, Greeneville, TN 37745 | 2017-01-11 |
| 1750635298 | Matthew Brandon Allen | Pharmacist | 515 Van Hill Rd, Greeneville, TN 37745 | 2012-11-06 |
| 1083963466 | Addison Dimartino | Optometrist | 204 Emory Dr, Greeneville, TN 37745 | 2012-08-31 |
| 1639443419 | State of Tennessee | Intermediate Care Facility, Mentally Retarded | 2499 Buckingham Rd., Greeneville, TN 37745 | 2012-02-27 |
| 1477786168 | Mcfarland Group Inc. | Durable Medical Equipment & Medical Supplies | 1413 Tusculum Blvd, Greeneville, TN 37745 | 2009-08-27 |
| 1043458128 | Greenville Dental Associates, Pllc | Dentist | 1308 Tusculum Blvd., Greeneville, TN 37745 | 2009-01-28 |
| 1275779555 | Professional Hearing Aid Ctr | Hearing Aid Equipment | 705 Professional Plaza, #3, Greenville, TN 37745 | 2008-12-17 |
| Find all providers in zip 37745 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes 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. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144667908 | Brad S. Johnson, Dmd, Pllc | Dentist | 703 K St, Greeneville, TN 37745-6246 | 2013-06-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396199055 | Daniel Coke | Dentist | 1301 Medical Center Dr # 1601, Nashville, TN 37232-0028 | 2016-04-19 |
| 1467835140 | Amir Victor Francis | Dentist | 1100 Poplar View Ln N Ste 1, Collierville, TN 38017-9323 | 2015-06-30 |
| 1376939645 | Matthew Breit | Dentist | 1251 Wesley Dr Ste 101, Memphis, TN 38116-6442 | 2015-04-13 |
| 1720472855 | Charles Baker Felts Iv | Dentist | 901 Riverfront Pkwy Ste 202, Chattanooga, TN 37402-2193 | 2015-03-26 |
| 1073910725 | Nashville Oral Facial Surgery, Pllc | Dentist | 2400 Patterson St Ste 316, Nashville, TN 37203-6510 | 2014-11-24 |
| 1194122135 | Samuel Edward Molind | Dentist | 210 Memorial Dr, Bristol, TN 37620-1704 | 2014-11-19 |
| 1780094052 | Andrew Ferraro | Dentist | 2964 Miller Place Way, Knoxville, TN 37924-1673 | 2014-05-07 |
| 1144649393 | Thomas Bailey | Dentist | 3000 Stansberry Ln Ste 101, Franklin, TN 37069-5125 | 2014-04-15 |
| 1376962613 | John Christopher Swearingen | Dentist | 780 Ridge Lake Blvd Ste 101, Memphis, TN 38120 | 2014-04-15 |
| 1427471382 | Oral & Maxillofacial Surgery Clinic Inc. | Dentist | 910 Madison Ave Ste 710, Memphis, TN 38103-3453 | 2014-01-29 |
| Find all providers with the same taxonomy | ||||
| City | GREENEVILLE |
| Zip Code | 37745 |
Please comment or provide details below to improve the information on EAST TENNESSEE ORAL & MAXILLOFACIAL SURGERY, PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.