Randall Mark Wilk MD DDS PHD

NPI 1669578944 - Dentist - 1223S0112X

NPI Details
NPI 1669578944
Gender Male
Enumeration Date 09/15/2006
Last Updated 04/22/2013
Entity Type Individual
Active Over 10 years ago
Practice Location
120 MEADOWCREST ST.
SUITE 300
GRETNA LA, 70056, US
Phone (504) 362-6135
Fax (504) 362-6134
Business Location
120 MEADOWCREST ST.
SUITE 300
GRETNA LA, 70056, US
Phone (504) 362-6135
Fax (504) 362-6134
Toxanomy
Taxonomy Code 1223S0112X
License State Louisiana
License Number 4669
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According to our database, Randall Mark Wilk MD DDS PHD NPI is 1669578944, taxonomy code is 1223S0112X and license number is 4669, license state is located at Louisiana. Randall Mark Wilk MD DDS PHD physically located at 120 Meadowcrest St., Gretna LA, 70056. NPI Number Randall Mark Wilk MD DDS PHD has the Individual type.

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1669578944 NPI number is provided on an as is basis without warranty of any kind. 1669578944 is maintained by the National Plan & Provider Enumeration System. The contents of Randall Mark Wilk MD DDS PHD are for informational purposes only.