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Edison Lakes Oral Surgery, P.C. — NPI 1881887065, South Bend, IN | NPI Central

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NPI 1881887065

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Edison Lakes Oral Surgery, P.C.

NPI 1881887065 · Oral and Maxillofacial Surgery Clinic/Center · South Bend, IN

Provider details

NPI number: 1881887065
Entity type: Organization
Primary specialty: Oral and Maxillofacial Surgery Clinic/CenterAmbulatory Health Care Facilities
Organization subpart: No
Authorized official: Edward Collins, Owner(574) 272-8823

Specialties & taxonomies

Oral and Maxillofacial Surgery Clinic/CenterPrimary261QS0112XLicense 12010802A (IN)
Ambulatory Health Care Facilities
Oral and Maxillofacial Surgery (Dentist)1223S0112X
Dental Providers

Practice location

3367 Douglas Rd

South Bend, IN 46635-1779

Phone: (574) 272-8823

Fax: (574) 277-1837

Approximate (ZIP-level) locationGet directions

More IN providers

Mailing address

3367 Douglas Rd

South Bend, IN 46635-1779

Other names (DBA / former)

Doing business as: Oral Surgery Michiana

Registry dates

Enumerated: 2007-08-22
Last updated: 2024-05-06
Certified: 2024-05-06

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.