East Tennessee Oral & Maxillofacial Surgery, Pc
LBN: East Tennessee Oral & Maxillofacial Surgery, Pc
East Tennessee Oral & Maxillofacial Surgery, Pc is an health care organization with primary practice located at 1505 E Lamar Alexander Pkwy , Maryville TN 37804-5131. The organization recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as the primary health care specialty.
East Tennessee Oral & Maxillofacial Surgery, Pc can be contacted via phone (865) 983-8630, or through Widloski, Mark M. via phone (865) 983-8630.
Contact Information
Primary practice address
1505 E Lamar Alexander Pkwy
Maryville TN 37804-5131
Phone: (865) 983-8630
Fax: (865) 981-4914
Website:
Authorized official contact:
Name: Widloski, Mark M. Doctor of Dental Surgery (DDS)
Phone: (865) 983-8630
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | DS1794 | Tennessee |
Profile Details
| NPI number | 1174624498 |
|---|---|
| LBN Legal business name | East Tennessee Oral & Maxillofacial Surgery, Pc |
| DBA Doing business as | |
| Authorized official | Widloski, Mark M. Doctor of Dental Surgery (DDS) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Sep 26th, 2006 |
| Last updated | Nov 18th, 2010 - about 14 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1174624498 | NPPES |
| Tennessee | MEDICAID | 3205757 |
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