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EDISON LAKES ORAL SURGERY P.C. NPI 1881887065


NPI Information

NPI: 1881887065
Provider Name: EDISON LAKES ORAL SURGERY, P.C.
Classification: Clinic/Center - 261QS0112X
Entity Type: Organization

Specialization: Oral and Maxillofacial Surgery

Address:
270 E DAY RD
SUITE 260
MISHAWAKA, IN
ZIP 46545
Phone: (574) 272-8823
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EDISON LAKES ORAL SURGERY, P.C. is an oral and maxillofacial surgery clinic center in Mishawaka, 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's business location address is:

270 E DAY RD
SUITE 260
MISHAWAKA, IN
ZIP 46545-444
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 7/15/2022.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223S0112XDentistOral and Maxillofacial SurgeryNo
2261QS0112XClinic/CenterOral and Maxillofacial Surgery12010802AINDIANAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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