National Provider Identifier Database

EDISON LAKES ORAL SURGERY PC
Oral and Maxillofacial Surgery

The specialty of dentistry which includes 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.


Contact Information

EDISON LAKES ORAL SURGERY, P.C.
3367 DOUGLAS RD
SOUTH BEND, IN46635-1779
Phone: 574-272-8823
Fax: 574-277-1837
Website:
Specialty Taxonomy Code
* Oral and Maxillofacial Surgery 261QS0112X
Oral and Maxillofacial Surgery 1223S0112X

* Indicates primary specialty

NPI Profile & details for EDISON LAKES ORAL SURGERY, P.C.

NPI Number 1881887065
Legal business name
LBN
EDISON LAKES ORAL SURGERY, P.C.
Authorized official EDWARD COLLINS - (OWNER)
Entity Organization
Organization subpart No
Enumeration date 08/22/2007
Last updated 05/06/2024 - About 2 years ago
Sole proprietor1 Not specified
Identifiers
  • IN License #: 12010802A

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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