| East Tennessee Oral & Maxillofacial Surgery, Pc | |
|
1505 E Lamar Alexander Pkwy Maryville TN 37804-5131 | |
| (865) 983-8630 | |
| (865) 981-4914 |
| Full Name | East Tennessee Oral & Maxillofacial Surgery, Pc |
|---|---|
| Speciality | Dentist |
| Location | 1505 E Lamar Alexander Pkwy, Maryville, Tennessee |
| Authorized Official Name and Position | Mark M. Widloski (OWNER/SURGEON) |
| Authorized Official Contact | 8659838630 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Tennessee Oral & Maxillofacial Surgery, Pc 1505 E Lamar Alexander Pkwy Maryville TN 37804-5131 Ph: (865) 983-8630 | East Tennessee Oral & Maxillofacial Surgery, Pc 1505 E Lamar Alexander Pkwy Maryville TN 37804-5131 Ph: (865) 983-8630 |
| NPI Number | 1174624498 |
|---|---|
| Provider Enumeration Date | 09/26/2006 |
| Last Update Date | 11/18/2010 |
| Medicare PECOS PAC ID | 9234103359 |
|---|---|
| Medicare Enrollment ID | O20040824001131 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174624498 | NPI | - | NPPES |
| 3205757 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | DS1794 (Tennessee) | Primary |
| Provider Name | Troy A Trondson |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1093925497 PECOS PAC ID: 2365513462 Enrollment ID: I20080617000699 |
| Provider Name | Brock Evans |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1073785010 PECOS PAC ID: 3476624586 Enrollment ID: I20080617000773 |
| Provider Name | Mark M Widloski |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1285631135 PECOS PAC ID: 4981733391 Enrollment ID: I20100525000036 |
| Provider Name | William May |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1578798666 PECOS PAC ID: 3072813740 Enrollment ID: I20151202000800 |
| Provider Name | Gregory A Conner |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1083785091 PECOS PAC ID: 5496995805 Enrollment ID: I20230420000931 |
Monica T Ginart Dmd Ms Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2014 W Broadway Ave, Maryville, TN 37801 Phone: 865-724-0505 | |
Maryville Dental Care Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1401 Montvale Station Rd, Maryville, TN 37803 Phone: 865-984-3800 | |
Prohealth Senior Services Of Virginia Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 811 High St, Maryville, TN 37804 Phone: 844-700-0088 | |
Charles H. Shanks, D.d.s., P.c. Dental Clinic Medicare: Medicare Enrolled Practice Location: 1511 E Lamar Alexander Pkwy, Maryville, TN 37804 Phone: 865-977-8048 Fax: 865-977-0318 | |
Curtiss Dentistry Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1507 East Lamar Alexander Pkwy, Maryville, TN 37804 Phone: 865-984-3211 Fax: 865-984-9858 | |
Carroll R. Shanks, D.d.s., P.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1511 E Lamar Alexander Pkwy, Maryville, TN 37804 Phone: 865-977-8048 Fax: 865-977-0318 | |
Emert-moss Dentistry Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1916 E Lamar Alexander Pkwy, Maryville, TN 37804 Phone: 865-983-4642 Fax: 865-983-9925 |