East Tennessee Oral & Maxillofacial Surgery, Pc
Oral and Maxillofacial Dental Clinic
1505 E Lamar Alexander Pkwy, Maryville
Tennessee, 37804-5131
865-983-8630 865-981-4914
Maps & DirectionsEast Tennessee Oral & Maxillofacial Surgery, Pc is a Oral and Maxillofacial Dental Clinic in Maryville, Tennessee. It is located at 1505 E Lamar Alexander Pkwy, Maryville, TN and its contact number is 865-983-8630. The authorized person for East Tennessee Oral & Maxillofacial Surgery, Pc is Dr. Mark M. Widloski
who is Owner/surgeon of the clinic and their contact number is 865-983-8630. The primary license number for East Tennessee Oral & Maxillofacial Surgery, Pc is DS1794 (Oral and Maxillofacial Surgery) in Tennessee.
East Tennessee Oral & Maxillofacial Surgery, Pc Clinic deals with 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.
Complete Clinic Profile:
East Tennessee Oral & Maxillofacial Surgery, Pc Clinic speciality, address, contact phone number and fax are as below.
Patients can call on the below given phone number for appointments.
| Name: | East Tennessee Oral & Maxillofacial Surgery, Pc |
| Specialization: | Oral and Maxillofacial Surgery |
| Clinic Address: | 1505 E Lamar Alexander Pkwy, Maryville,
Tennessee, 37804-5131 |
| Phone: | 865-983-8630 |
| Fax: | 865-981-4914 |
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints for this clinic are as below. Person's position and contact details are also mentioned below.
| Name: | Dr. Mark M. Widloski |
| Position: | Owner/surgeon |
| Contact Number: | 865-983-8630 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details for East Tennessee Oral & Maxillofacial Surgery, Pc clinic are as mentioned below.
| NPI Number: | 1174624498 |
| NPI Enumeration Date: | 26 Sep, 2006 |
| NPI Last Update On: | 18 Nov, 2010 |
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for East Tennessee Oral & Maxillofacial Surgery, Pc are as mentioned below.
| Specialization | License Number | State | Status | |
| Oral and Maxillofacial Surgery | DS1794 | Tennessee | Primary | |
Other Medical Identifiers:
Other legacy medical identifiers of the clinic such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 3205757 | Medicaid | Tennessee | |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | East Tennessee Oral & Maxillofacial Surgery, Pc
1505 E Lamar Alexander Pkwy,
Maryville, Tennessee |
| Zip: | 37804-5131 |
| Phone Number: | 865-983-8630 |
| Fax Number: | 865-981-4914 |
Patients can reach East Tennessee Oral & Maxillofacial Surgery, Pc at
1505 E Lamar Alexander Pkwy, Maryville, Tennessee or can
call to book an appointment on 865-983-8630.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on
08 December, 2025.