# MICHIANA ORAL &MAXILLOFACIAL SURGERY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093775272
- **Authorized official:** BERNARD J ASDELL DDS (OWNER)
- **Authorized official phone:** (574) 289-0080

## Contact information

- **Practice address:** 707 N MICHIGAN ST, SUITE 300, SOUTH BEND, IN 46601-1070
- **Practice address phone:** (574) 289-0080
- **Practice address fax:** (574) 287-6320
- **Mailing address:** 707 N MICHIGAN ST, SUITE 300, SOUTH BEND, IN 46601-1070
- **Mailing address phone:** (574) 289-0080
- **Mailing address fax:** (574) 287-6320

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 12008287 | IN | Yes |

## Other

- **Enumeration date:** 03/23/2006
- **Last updated:** 04/18/2012