Widloski, Mark M.
Widloski, Mark M. is an individual health care provider with primary practice located at 1505 E Lamar Alexander Pkwy , Maryville TN 37804-5131. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Widloski, Mark M. can be contacted via phone (865) 983-8630.Contact Information
Primary practice address
1505 E Lamar Alexander Pkwy
Maryville TN 37804-5131
Phone: (865) 983-8630
Fax: (865) 983-3616
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | DS4711 | Tennessee |
Profile Details
| NPI number | 1285631135 |
|---|---|
| LBN Legal business name | Widloski, Mark M. |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 7th, 2005 |
| Last updated | Oct 10th, 2011 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1285631135 | NPPES |
| Tennessee | MEDICAID | 3225440 |
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