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Individual
RANDALL MARK WILK
Active
Individual
RANDALL MARK WILK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD DDS PHD
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
Enumeration date
09/15/2006
Last updated
04/22/2013
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