Widloski, Mark M.

Widloski, Mark M. is an individual health care provider with primary practice located at 1505 E Lamar Alexander Pkwy , Maryville TN 37804-5131. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Widloski, Mark M. can be contacted via phone (865) 983-8630.

Contact Information

Primary practice address
1505 E Lamar Alexander Pkwy Maryville TN 37804-5131
Fax: (865) 983-3616
Website:

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X DS4711 Tennessee

Profile Details

NPI number 1285631135
LBN Legal business name Widloski, Mark M.
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 7th, 2005
Last updated Oct 10th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285631135 NPPES
Tennessee MEDICAID 3225440

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