EDISON LAKES ORAL SURGERY P.C. NPI 1881887065

NPI Information

  • NPI: 1881887065
  • Provider Name: EDISON LAKES ORAL SURGERY, P.C.
  • Classification: Clinic/Center - 261QS0112X
  • Specialization: Oral and Maxillofacial Surgery
  • Entity Type: Organization
  • Doing Business As: ORAL SURGERY MICHIANA
  • Address: 3367 DOUGLAS RD
    SOUTH BEND, IN
    ZIP 46635
  • Phone: (574) 272-8823

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NPI Details

EDISON LAKES ORAL SURGERY, P.C. is an oral and maxillofacial surgery clinic center in South Bend, IN. The provider is an oral and maxillofacial surgery clinic or center specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. EDISON LAKES ORAL SURGERY, P.C. NPI is 1881887065. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Oral Surgery Michiana.

The provider's business location address is:

3367 DOUGLAS RD
SOUTH BEND, IN
ZIP 46635-779
Phone: (574) 272-8823
Fax: (574) 277-1837

The provider's authorized official is Edward Charles Collins .
The authorized official title is Owner and has the following contact phone number (574) 272-8823.

The enumeration date for this NPI number is 8/22/2007 and was last updated on 5/6/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223S0112XDentistOral and Maxillofacial SurgeryNo
2261QS0112XClinic/CenterOral and Maxillofacial Surgery12010802AINDIANAYes

What is NPI?

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This page was last updated on: 11/21/2025

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