| Michiana Oral &maxillofacial Surgery Llc | |
|
707 N Michigan St Suite 300 South Bend IN 46601-1070 | |
| (574) 289-0080 | |
| (574) 287-6320 |
| Full Name | Michiana Oral &maxillofacial Surgery Llc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 707 N Michigan St, South Bend, Indiana |
| Authorized Official Name and Position | Bernard J Asdell (OWNER) |
| Authorized Official Contact | 5742890080 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michiana Oral &maxillofacial Surgery Llc 707 N Michigan St Suite 300 South Bend IN 46601-1070 Ph: (574) 289-0080 | Michiana Oral &maxillofacial Surgery Llc 707 N Michigan St Suite 300 South Bend IN 46601-1070 Ph: (574) 289-0080 |
| NPI Number | 1093775272 |
|---|---|
| Provider Enumeration Date | 03/23/2006 |
| Last Update Date | 04/18/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093775272 | NPI | - | NPPES |
| 100409820A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 12008287 (Indiana) | Primary |
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