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Organization
RANDALL M. WILK, MD, DDS, PHD, APMC
Active
Organization
RANDALL M. WILK, MD, DDS, PHD, APMC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL M. WILK MD (OWNER)
(504) 362-6135
Entity
Organization
Contact information
Practice address
120 MEADOWCREST ST, #300, GRETNA, LA 70056
(504) 362-6135
(504) 362-6134
Mailing address
120 MEADOWCREST ST, #300, GRETNA, LA 70056
(504) 362-6135
(504) 362-6134
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
4669
LA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
022962
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1890197
—
LA
Enumeration date
05/13/2007
Last updated
10/11/2013
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