| Randall E Wilson | |
|
4121 Old Collinsville Rd Swansea IL 62226-2511 | |
| (618) 236-0501 | |
| Not Available |
| Full Name | Randall E Wilson |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4121 Old Collinsville Rd, Swansea, Illinois |
| Authorized Official Name and Position | Randall E Wilson (OWNER) |
| Authorized Official Contact | 6182360501 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Randall E Wilson 4121 Old Collinsville Rd Swansea IL 62226-2511 Ph: (618) 236-0501 | Randall E Wilson 4121 Old Collinsville Rd Swansea IL 62226-2511 Ph: (618) 236-0501 |
| NPI Number | 1891316535 |
|---|---|
| Provider Enumeration Date | 05/05/2020 |
| Last Update Date | 05/05/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891316535 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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