| NPI | 1174624498 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK M. WIDLOSKI Owner/Surgeon 865-983-8630 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN DS1794) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2010-11-18 |