EAST TENNESSEE ORAL & MAXILLOFACIAL SURGERY, PC (NPI# 1306156302) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306156302 |
| Entity Type | Organization |
| Organization Name | EAST TENNESSEE ORAL & MAXILLOFACIAL SURGERY, PC |
| Practice Address |
700 S Illinois Ave Bldg A, Suite 104 Oak Ridge TN 37830-7900 |
| Mailing Address |
1505 E Lamar Alexander Pkwy Maryville TN 37804-5131 |
| Practice Telephone | 8654822600 |
| Practice Fax Number | 8654822636 |
| 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 |
| 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 |
| 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 |
700 S ILLINOIS AVE BLDG A, SUITE 104 |
| City | OAK RIDGE |
| State | TN |
| Zip Code | 37830-7900 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194388702 | Oak Ridge Pharmacy | Pharmacy | 854 Main St W, Oak Ridge, TN 37830 | 2019-04-18 |
| 1134682693 | Mac's Pharmacy Oak Ridge, LLC | Pharmacy | 45 New York Avenue, Oak Ridge, TN 37830 | 2019-04-11 |
| 1689153876 | Tapuwa Martin Chikowore | Dentist | 377 S Illinois Ave, Oak Ridge, TN 37830 | 2018-08-09 |
| 1710475660 | Oak Ridge Smiles Dentistry, PC | Dentist | 377 S. Illinois Ave., Oak Ridge, TN 37830 | 2018-04-26 |
| 1417344763 | Heather Cupp | Social Worker | 723 Emory Valley Road, Oak Ridge, TN 37830 | 2015-04-23 |
| 1366701534 | Quality Care From The Heart | Preferred Provider Organization | 144 Newport Drive, Oak Ridge, TN 37830 | 2012-05-09 |
| 1578838223 | Second Chance Recovery In Faith, Inc | Community/Behavioral Health | 234 W Tennessee Ave, Oak Ridge, TN 37830 | 2012-03-14 |
| 1720364615 | Douglas Miller | Pharmacist | 1299 Oak Ridge Turnpike, Oak Ridge, TN 37830 | 2011-10-24 |
| 1619263852 | Namratha Reddy Vontela | Internal Medicine | 200 New York Ave Ste 200, Oak Ridge, TN 37830 | 2011-06-27 |
| 1356658165 | Fred Lewis Stephens | Social Worker | 150 E Division Rd Ste 10, Oak Ridge, TN 37830 | 2010-09-01 |
| Find all providers in zip 37830 | ||||
| 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 |
|---|---|---|---|---|
| 1043234750 | Andrew C Cheung | Dentist | 140 E. Division Road, Suite A-1, Oak Ridge, TN 37830 | 2006-07-26 |
| 1346225554 | Thomas D Moye | Dentist | 420 Laboratory Rd, Oak Ridge, TN 37830-6802 | 2005-12-09 |
| 1619952850 | Travis A. Witherington | Dentist | 140 E. Division Rd, Suite A-1, Oak Ridge, TN 37830 | 2005-12-09 |
| 1104261023 | John Hideo Mizukawa II | Dentist | 140 E Division Rd, Oak Ridge, TN 37830-6937 | 2013-05-06 |
| 1164679874 | Lindsey Ann Nagy | Dentist | 140 E Division Rd, Oak Ridge, TN 37830-6937 | 2008-08-25 |
| 1356414189 | Oral & Maxillofacial Surgical Specialists | Dentist | 420 Laboratory Rd, Oak Ridge, TN 37830-6802 | 2006-11-17 |
| 1346225042 | James David Johnson Jr. | Dentist | 420 Laboratory Rd, Oak Ridge, TN 37830-6802 | 2005-12-14 |
| 1336124577 | Brett J Jaffrey | Dentist | 420 Laboratory Rd, Oak Ridge, TN 37830-6802 | 2005-12-09 |
| 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 | ||||
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| 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.