EAST TENNESSEE ORAL AND MAXILLOFACIAL SURGERY, PC (NPI# 1861701005) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861701005 |
| Entity Type | Organization |
| Organization Name | EAST TENNESSEE ORAL AND MAXILLOFACIAL SURGERY, PC |
| Practice Address |
161 Capital Drive Suite102 Knoxville TN 37922-3357 |
| Mailing Address |
1505 E Lamar Alexander Pkwy Maryville TN 37804-5131 |
| Practice Telephone | 8655313909 |
| Practice Fax Number | 8655390022 |
| Mailing Telephone | 8659838630 |
| Mailing Fax Number | 8659814914 |
| Enumeration Date | 2010-10-06 |
| Last Update Date | 2010-11-29 |
| 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 |
| Street Address |
161 CAPITAL DRIVE SUITE102 |
| City | KNOXVILLE |
| State | TN |
| Zip Code | 37922-3357 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184132185 | Kimberly Zitko | Pharmacist | 400 Goody's Lane, Knoxville, TN 37922 | 2018-01-12 |
| 1366959314 | Matthew Smith | Physician Assistant | 1424 Randall Park Dr, Knoxville, TN 37922 | 2017-12-29 |
| 1174052823 | 24/7 Healthcare, Inc. | Nursing Care | 110 Center Park Drive, Suite 101, Knoxville, TN 37922 | 2017-06-07 |
| 1023543477 | Open Arms Care Corp | Intermediate Care Facility, Mentally Retarded | 12625 S Northshore Dr, Knoxville, TN 37922 | 2017-04-24 |
| 1275905440 | Milligan Surgical Associates, Pllc | Surgery | 1919 Pinnacle Pointe Way, Knoxville, TN 37922 | 2015-10-27 |
| 1275904096 | Medical Necessities & Services LLC | Durable Medical Equipment & Medical Supplies | 9327 S Northshore Dr, Knoxville, TN 37922 | 2015-10-20 |
| 1841668126 | Chad Szala | Behavioral Analyst | 10721 Chapman Hwy #22, Knoxville, TN 37922 | 2015-09-03 |
| 1275916470 | Nikki Nicole Peoples | Acupuncturist | 10406 Jackson Oaks Way Ste A, Knoxville, TN 37922 | 2015-07-07 |
| 1538577747 | Susan Carter | Optometrist | 2053 Thunderhead Rd, Knoxville, TN 37922 | 2014-07-31 |
| 1366868135 | Heartland Infusion | Clinic/Center | 9943 Kingston Pike, Knoxville, TN 37922 | 2014-03-17 |
| Find all providers in zip 37922 | ||||
| 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 |
|---|---|---|---|---|
| 1780094052 | Andrew Ferraro | Dentist | 2964 Miller Place Way, Knoxville, TN 37924-1673 | 2014-05-07 |
| 1275809394 | William R. High, D.m.d., P.C. | Dentist | 248 North Peters Peters Road, Suite 3, Knoxville, TN 37923 | 2012-03-23 |
| 1104009646 | Joshua A Campbell | Dentist | 11213 West Point Dr., Knoxville, TN 37934-2838 | 2007-12-06 |
| 1467651745 | Nicole Case Eisenberg | Dentist | 4533 Papermill Road, Knoxville, TN 37909 | 2007-07-16 |
| 1043259906 | Daniel S Read | Dentist | 111 Fox Rd Ste 201, Knoxville, TN 37922-3304 | 2006-06-06 |
| 1366739591 | Nathaniel G Wells | Dentist | 1930 Alcoa Hwy, A-335, Knoxville, TN 37920-1500 | 2011-07-08 |
| 1881992279 | Southeast Oral Surgery PC | Dentist | 130 Mabry Hood Rd, Suite 105, Knoxville, TN 37922-2221 | 2011-03-09 |
| 1225348220 | East Tennessee Oral & Maxillofacial Surgery, PC | Dentist | 2939 Essary Rd, Suite 1, Knoxville, TN 37918-2464 | 2010-10-12 |
| 1952547366 | Southeast Oral Surgery PC | Dentist | 801 W Oldham Ave, Knoxville, TN 37921-2747 | 2009-01-07 |
| 1336367382 | C. Edward Brooks | Dentist | 11226 W Point Dr, Suite B, Knoxville, TN 37934-2837 | 2007-04-23 |
| Find all providers in KNOXVILLE | ||||
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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.