NPI | 1285849166 |
---|---|
Entity Type | Organization |
Authorized Contact | RANDALL M. WILK Owner 504-362-6135 |
Organization Subpart ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: LA 022962) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA 4669) |
Enumeration Date | 2007-05-13 |
Last Update Date | 2013-10-11 |