EAST TENNESSEE ORAL & MAXILLOFACIAL SURGERY, PC (NPI# 1497065494) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497065494 |
| Entity Type | Organization |
| Organization Name | EAST TENNESSEE ORAL & MAXILLOFACIAL SURGERY, PC |
| Practice Address |
2253 Chambliss Ave Nw Suite 403 Cleveland TN 37311-3861 |
| Mailing Address |
1505 E Lamar Alexander Pkwy Maryville TN 37804-5131 |
| Practice Telephone | 4237090400 |
| Practice Fax Number | 4237090401 |
| 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 |
| 1033429030 | East Tennessee Oral & Maxillofacial Surgery, PC | Dentist | 703 K St, Greeneville, TN 37745-6246 | 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 |
2253 CHAMBLISS AVE NW SUITE 403 |
| City | CLEVELAND |
| State | TN |
| Zip Code | 37311-3861 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316988595 | William Frank Johnson II | Surgery | 2253 Chambliss Ave Nw, Suite 100, Cleveland, TN 37311-3861 | 2006-06-09 |
| 1033436837 | Asma N Khatri | Internal Medicine | 2253 Chambliss Ave Nw, Ste 400, Cleveland, TN 37311-3861 | 2010-05-03 |
| 1578798666 | William Russell May Jr. | Dentist | 2253 Chambliss Ave Nw, Suite 403, Cleveland, TN 37311-3861 | 2009-05-19 |
| 1013153857 | Margie Amanda Cook | Nurse Practitioner | 2253 Chambliss Ave Nw, Suite 202, Cleveland, TN 37311 | 2008-12-29 |
| 1144419458 | Skin Cancer & Cosmetic Dermatology Center, PC | Specialist | 2253 Chambliss Ave Nw, Suite 202, Cleveland, TN 37311-3861 | 2007-10-23 |
| 1982780060 | James Kent Hulvey | Nurse Practitioner | 2253 Chambliss Ave Nw, Suite 200, Cleveland, TN 37311-3861 | 2006-10-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114433570 | Kirstee Williams | Counselor | 1120 North Ocoee Street, Lee University, Cleveland, TN 37311 | 2017-12-21 |
| 1285070458 | Scott Daniel Pugh | Counselor | 183 1st St Ne, Cleveland, TN 37311 | 2013-05-15 |
| 1407299191 | Bess E Howard | Nurse Practitioner | 2449 Spring Creek Blvd, Ne, Cleveland, TN 37311 | 2013-04-11 |
| 1588913925 | Thomas C Reese | Hearing Instrument Specialist | 60 25th Street Ne, Suite 5, Cleveland, TN 37311 | 2012-08-30 |
| 1932484607 | Southeast Tn Human Resource Agency | Non-emergency Medical Transport (VAN) | 165 Edwards Street Se, Cleveland, TN 37311 | 2011-10-13 |
| 1588956106 | Lee M Radford | Orthopaedic Surgery | 2350 N Ocoee Street, Cleveland, TN 37311 | 2011-05-16 |
| 1124251913 | Mcfarland Group Inc. | Durable Medical Equipment & Medical Supplies | 1300 25th St Nw # 104, Cleveland, TN 37311 | 2009-08-27 |
| 1952554834 | Bradley Cleveland Services Inc | Counselor | 2611 Bower Lane, Cleveland, TN 37311 | 2008-10-23 |
| 1851543151 | Bradley Cleveland Services, Inc | Counselor | 2601 Bower Lane Se, Cleveland, TN 37311 | 2008-10-17 |
| 1306098082 | Kidney Center of Cleveland, LLC | Clinic/Center | 2253 Chambliss Avenue, Cleveland, TN 37311 | 2008-10-14 |
| Find all providers in zip 37311 | ||||
| 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 |
|---|---|---|---|---|
| 1467707018 | Matthew Aaron Popper | Dentist | 5825 Landerbrook Dr Ste 125, Cleveland, OH 44124 | 2012-07-19 |
| 1902084056 | Allen K Herpy Dds Ms Inc | Dentist | 6770 Mayfield Rd # 420, Cleveland, OH 44124-2299 | 2008-01-31 |
| 1467522128 | Donald Yezerski | Dentist | 7379 Pearl Rd, Suite 2, Cleveland, OH 44130-4898 | 2006-11-09 |
| 1003882333 | Craig Francis Mangie | Dentist | 9500 Euclid Ave # Deska71, Cleveland, OH 44195-4501 | 2006-02-27 |
| 1457340036 | Frank J. Karfes | Dentist | 850 Euclid Ave, Suite 500, Cleveland, OH 44114 | 2005-10-17 |
| 1124472139 | Nada Alwanni | Dentist | 2124 Cornell Rd, Cleveland, OH 44106-3804 | 2016-04-15 |
| 1538536792 | Jasem Alburaih | Dentist | 2124 Cornell Rd, Cleveland, OH 44106 | 2015-08-24 |
| 1780081596 | Juan Troconis | Dentist | 2500 Metrohealth Drive, Cleveland, OH 44109 | 2014-11-21 |
| 1205247798 | Noureddin Khazam | Dentist | 2500 Metrohealth Dr, Cleveland, OH 44109-1998 | 2014-05-19 |
| 1104059658 | Case Dental Medicine Support Services, LLC. | Dentist | 2124 Cornell Road, Cleveland, OH 44106-4905 | 2009-09-01 |
| Find all providers in CLEVELAND | ||||
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.