Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
RANDALL MARK WILK, MD DDS PHD
Active Sole ProprietorRANDALL MARK WILK, MD DDS PHD is a Oral & Maxillofacial Surgery (Physician) healthcare provider located in GRETNA, Louisiana. NPI 1669578944 is currently active in the NPPES registry. Verify at CMS.
Oral & Maxillofacial Surgery (Physician) · GRETNA, LA
Registration Details
- NPI Number
- 1669578944
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Sep 15, 2006 (19.942635220926 yrs)
- Last Updated
- Apr 22, 2013
- Licenses
-
4669 (LA)022962 (LA)
- Sole Proprietor
- Yes
Practice Information
- Address
-
120 MEADOWCREST ST.SUITE 300GRETNA, LA, 70056Browse LA providers · Browse ZIP 70056
- Phone
- 5043626135
- Fax
- 5043626134
- Primary Specialty
-
Oral & Maxillofacial Surgery (Physician)
204E00000X
- Additional Specialty
- Oral & Maxillofacial Surgery (Physician)
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.