| Edison Lakes Oral Surgery, P.c. | |
|
270 E Day Rd Suite 260 Mishawaka IN 46545-3444 | |
| (574) 272-8823 | |
| (574) 277-1837 |
| Full Name | Edison Lakes Oral Surgery, P.c. |
|---|---|
| Speciality | Clinic/center - Oral And Maxillofacial Surgery |
| Location | 270 E Day Rd, Mishawaka, Indiana |
| Authorized Official Name and Position | Edward Charles Collins (OWNER) |
| Authorized Official Contact | 5742728823 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Edison Lakes Oral Surgery, P.c. 270 E. Day Rd. Suite 260 Mishawaka IN 46545-3464 Ph: (574) 272-8823 | Edison Lakes Oral Surgery, P.c. 270 E Day Rd Suite 260 Mishawaka IN 46545-3444 Ph: (574) 272-8823 |
| NPI Number | 1881887065 |
|---|---|
| Provider Enumeration Date | 08/22/2007 |
| Last Update Date | 07/15/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881887065 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Secondary |
| 261QS0112X | Clinic/center - Oral And Maxillofacial Surgery | 12010802A (Indiana) | Primary |
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