RANDALL MARK WILK (NPI# 1669578944) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669578944 |
| Entity Type | Individual |
| Full Name | RANDALL MARK WILK |
| Credential | MD DDS PHD |
| Practice Address |
120 Meadowcrest St. Suite 300 Gretna LA 70056 |
| Practice Telephone | 5043626135 |
| Practice Fax Number | 5043626134 |
| Mailing Telephone | 5043626135 |
| Mailing Fax Number | 5043626134 |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2013-04-22 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
4669 | LA | Dental Providers |
| Y | 204E00000X | Oral & Maxillofacial Surgery | 022962 | LA | Allopathic & Osteopathic Physicians |
| Street Address |
120 MEADOWCREST ST. SUITE 300 |
| City | GRETNA |
| State | LA |
| Zip Code | 70056 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376074252 | Children's International, LLC | Clinic/Center | 120 Meadowcrest St., Ste 470, Gretna, LA 70785 | 2017-03-23 |
| 1629244132 | Deregal Fay Burbank | Pediatrics | 120 Meadowcrest St., Suite 245, Gretna, LA 70056 | 2008-05-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023634169 | Krewe Wellness | Counselor | 2112 Belle Chasse Hwy Ste 8, #156, Gretna, LA 70056 | 2020-06-24 |
| 1205459732 | Gulf Coast Medical Specialists LLC | Internal Medicine | 1620 Belle Chasse Hwy Suite 101, Gretna, LA 70056 | 2020-05-19 |
| 1427530872 | Anna Marie Mckeon Jr. | Social Worker | 410 W. Butterfly Circle, Terrytown, LA 70056 | 2018-09-02 |
| 1558843219 | Nikell Thompson Fortia | Non-emergency Medical Transport (VAN) | 561 Morningside Dr, Gretna, LA 70056 | 2018-08-29 |
| 1861979379 | Irajuan L Cooley | Case Manager/Care Coordinator | 1620 Carol Sue Ave Apt 219, Gretna, LA 70056 | 2018-07-26 |
| 1457842528 | Veronica Stevenson | Case Manager/Care Coordinator | 1799 Stumpf Blvd Ste 4a, Terrytown, LA 70056 | 2018-05-24 |
| 1184126278 | Elesha Loston | Case Manager/Care Coordinator | 1799 Stumpf Blvd. Bldg .7 Suite 9a, Gretna, LA 70056 | 2018-03-05 |
| 1336656149 | Porsha D Causey | Counselor | 1799 Stumpf Blvd Bldg 7 Ste 10, Ste 10, Gretna, LA 70056 | 2018-01-02 |
| 1265950745 | Tamika Nicole Deville | Counselor | Advanced Therapeutic, 1799 Stumpf Blvd Bld 3 Ste 4b, Terrytown, LA 70056 | 2017-09-05 |
| 1679098792 | Clear Head Inc | Clinic/Center | 2310 Park Place Dr., Terrytown, LA 70056 | 2017-08-09 |
| Find all providers in zip 70056 | ||||
| Taxonomy Code | 204E00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Oral & Maxillofacial Surgery |
| Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. |
| Notes: Source: American College of Surgeons, 2013. www.facs.org [7/1/2013: definition added, source added, additional resources added] Additional Resources: American Board of Oral and Maxillofacial Surgery and American Association of Oral and Maxillofacial Surgeons While this is generally considered a specialty of dentistry, physicians can also be board certified as oral and maxillofacial surgeons through the American Board of Oral and Maxillofacial Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932414851 | Michael D. Daigle Dds Apc | Oral & Maxillofacial Surgery | 100 Melissa Ln, Houma, LA 70360-4058 | 2010-08-16 |
| 1598927196 | Ashraf R Heram | Oral & Maxillofacial Surgery | 1100 Florida Ave # 220, New Orleans, LA 70119-2714 | 2008-06-26 |
| 1194996637 | Richard Tipery Akin | Oral & Maxillofacial Surgery | 614 Connells Park Ln, Baton Rouge, LA 70806-6534 | 2008-03-12 |
| 1114121639 | Hugo St Hilaire | Oral & Maxillofacial Surgery | 2820 Napoleon Ave Ste 810, New Orleans, LA 70115-8235 | 2007-06-11 |
| 1477630515 | Richard Tipery Akin Dds Md Apc | Oral & Maxillofacial Surgery | 614 Connells Park Lane, Baton Rouge, LA 70806 | 2006-11-01 |
| 1033292008 | Michael Delano Daigle | Oral & Maxillofacial Surgery | 100 Melissa Lane, Houma, LA 70360 | 2006-10-23 |
| 1942391362 | Frank W Harmon | Oral & Maxillofacial Surgery | 2120 Bert Kouns, Suite D, Shreveport, LA 71118 | 2006-09-28 |
| 1508877580 | Ronald B Marks | Oral & Maxillofacial Surgery | 1403 Peterman Drive, Alexandria, LA 71301 | 2006-08-11 |
| 1275513798 | Southpark Community Hospital | Oral & Maxillofacial Surgery | 314 Youngsville Hwy, Lafayette, LA 70508-4524 | 2006-01-19 |
| 1588641096 | Alexandria Oral Surgery Associates LLP | Oral & Maxillofacial Surgery | 1403 Peterman Dr, Alexandria, LA 71301-3433 | 2005-12-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.