Randal Todd Wilson, DMD - Medicare Dentist in Burley, ID

Randal Todd Wilson, DMD is a medicare enrolled "Dentist" provider in Burley, Idaho. His current practice location is 1309 Bennett Ave, Burley, Idaho. You can reach out to his office (for appointments etc.) via phone at (208) 677-5198.

Randal Todd Wilson is licensed to practice in Idaho (license number D-4526) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1063846459.

Contact Information

Randal Todd Wilson, DMD
1309 Bennett Ave,
Burley, ID 83318-2676
(208) 677-5198
Not Available



Healthcare Provider's Profile

Full NameRandal Todd Wilson
GenderMale
SpecialityDentist
Location1309 Bennett Ave, Burley, Idaho
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1063846459
  • Provider Enumeration Date: 08/21/2013
  • Last Update Date: 03/17/2021
  Medicare PECOS Information:
  • PECOS PAC ID: 6406143916
  • Enrollment ID: I20160927003114

Medical Identifiers

Medical identifiers for Randal Todd Wilson such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1063846459NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
122300000XDentist D-4526 (Idaho)Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Randal Todd Wilson is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Randal Todd Wilson, DMD
794 Eastland Dr,
Twin Falls, ID 83301-6856

Ph: (208) 734-3312
Randal Todd Wilson, DMD
1309 Bennett Ave,
Burley, ID 83318-2676

Ph: (208) 677-5198

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Dentist in Burley, ID

Dr. Michael Bryson Stucki, DDS
Dentist
Medicare: Not Enrolled in Medicare
Practice Location: 1706 Overland Ave, Burley, ID 83318
Phone: 208-678-2332    
Dr. Kevin D. Banner, D.D.S.
Dentist
Medicare: Not Enrolled in Medicare
Practice Location: 1010 E Main St, Burley, ID 83318
Phone: 208-678-5597    Fax: 208-678-5663
Dr. Steve Paul Garn, D.D.S.
Dentist
Medicare: Not Enrolled in Medicare
Practice Location: 2200 Park Ave, Suite 2, Burley, ID 83318
Phone: 208-678-8188    Fax: 208-678-3170
Wayne Jack Wright, D.D.S.
Dentist
Medicare: Medicare Enrolled
Practice Location: 2200 Park Ave, Burley, ID 83318
Phone: 208-678-1478    
Logan Kay, DMD
Dentist
Medicare: Medicare Enrolled
Practice Location: 1309 Bennett Ave, Burley, ID 83318
Phone: 208-732-7447    
Dr. Justin Ward, D.M.D.
Dentist
Medicare: Not Enrolled in Medicare
Practice Location: 2271 Overland Ave, Suite 4, Burley, ID 83318
Phone: 208-678-3265    

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