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East Tennessee Oral & Maxillofacial Surgery, PC

NPI #1306156302 in Oak Ridge, Tennessee

Provider Information

NPI Number
1306156302
Entity Type
Organization
Organization Name
East Tennessee Oral & Maxillofacial Surgery, PC
Primary Specialty
Dentist - Oral and Maxillofacial Surgery
Enumeration Date
Oct 12, 2010
Last Updated
Nov 18, 2010

Practice Location

Address
700 S ILLINOIS AVE
Address 2
BLDG A, SUITE 104
City
Oak Ridge
State
Tennessee
ZIP Code
37830-7900
Phone
(865) 482-2600

Authorized Official

Name
DR. MARK M WIDLOSKI, DDS
Title
OWNER
Phone
(865) 983-8630

Specialties & Taxonomy Codes

Specialty
Dentist - Oral and Maxillofacial Surgery — Oral and Maxillofacial Surgery

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