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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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