Randal Todd Wilson, DMD

NPI #1063846459 in Burley, Idaho

Provider Information

NPI Number: 1063846459
Entity Type: Individual
Name: Randal Todd Wilson, DMD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist
Credential: DMD
Enumeration Date: Aug 21, 2013
Last Updated: Mar 17, 2021

Practice Location

Address: 1309 BENNETT AVE
City: Burley
State: Idaho
ZIP Code: 83318-2676
Phone: (208) 677-5198

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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