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East Tennessee Oral & Maxillofacial Surgery, PC

Oral and Maxillofacial Surgery (Dentist) in Maryville, TN · enumerated 2006 · authorized official Mark Widloski, Owner/Surgeon.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1174624498

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Registry record

Entity type Organization (Type 2)
Legal business name East Tennessee Oral & Maxillofacial Surgery, PC
Practice address 1505 E Lamar Alexander Pkwy, Maryville, TN, 37804
Phone (865) 983-8630
Fax (865) 981-4914
Enumeration date Sep 26, 2006
Last updated in NPPES Nov 18, 2010

Taxonomy & classification

1223S0112X Oral and Maxillofacial Surgery (Dentist) Dental Providers · License DS1794 (TN) Primary

Authorized official

Name Mark Widloski
Title Owner/Surgeon
Phone (865) 983-8630

Other identifiers

Identifier Type State Issuer
3205757 Medicaid TN -

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

What is the NPI number for East Tennessee Oral & Maxillofacial Surgery, PC?
The NPI for East Tennessee Oral & Maxillofacial Surgery, PC is 1174624498, a Type 2 (organization) record in the CMS NPPES registry.
Who is the authorized official for East Tennessee Oral & Maxillofacial Surgery, PC?
NPPES lists Mark Widloski (Owner/Surgeon) as the authorized official for this organization.

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2010-11-18.