| East Tennessee Oral & Maxillofacial Surgery, Pc | |
|
700 S Illinois Ave Bldg A, Suite 104 Oak Ridge TN 37830-7900 | |
| (865) 482-2600 | |
| (865) 482-2636 |
| Full Name | East Tennessee Oral & Maxillofacial Surgery, Pc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 700 S Illinois Ave, Oak Ridge, Tennessee |
| Authorized Official Name and Position | Mark M Widloski (OWNER) |
| Authorized Official Contact | 8659838630 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| East Tennessee Oral & Maxillofacial Surgery, Pc 1505 E Lamar Alexander Pkwy Maryville TN 37804-5131 Ph: (865) 983-8630 | East Tennessee Oral & Maxillofacial Surgery, Pc 700 S Illinois Ave Bldg A, Suite 104 Oak Ridge TN 37830-7900 Ph: (865) 482-2600 |
| NPI Number | 1306156302 |
|---|---|
| Provider Enumeration Date | 10/12/2010 |
| Last Update Date | 11/18/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306156302 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 4711 (Tennessee) | Primary |
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