Randall Eugene Wilson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019-019975 Issued in IL

Practice address

4121 Old Collinsville Rd
Swansea, IL 62226-2441

Phone

(618) 236-0501

Fax

(618) 222-2997

NPI assigned

Mar 26, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Randall E Wilson DDS

  • Dental Clinic/Center
  • Swansea, IL
  • NPI 1891316535
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757462400000",
    "number": "1164540365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4121 OLD COLLINSVILLE RD",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622262441",
            "telephone_number": "618-236-0501",
            "fax_number": "618-222-2997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4121 OLD COLLINSVILLE RD",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622262441",
            "telephone_number": "618-236-0501",
            "fax_number": "618-222-2997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "RANDALL",
        "middle_name": "EUGENE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-26",
        "last_updated": "2025-09-10",
        "certification_date": "2025-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-019975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janet Wiley, MSW, LCSW
• William a. Victor
• Brandon Marshall Williams, DC, PA
• Lauren Brittany Wilson, DMD
• Michelle Wilson, MS, RD, LDN
• Anna Winkeler
• Winter Hall Counseling
• Cindy Lee Winters, LCSW
• Ebony T Winters
• Jovonda Monique Winters, MA, MA, MSW

• General Practice Dentistry in Swansea, IL
• Providers in Swansea, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.