Organization
MICHIANA ORAL &MAXILLOFACIAL SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BERNARD J ASDELL DDS (OWNER)
(574) 289-0080
Entity
Organization
Contact information
Practice address
707 N MICHIGAN ST, SUITE 300, SOUTH BEND, IN 46601-1070
(574) 289-0080
(574) 287-6320
Mailing address
707 N MICHIGAN ST, SUITE 300, SOUTH BEND, IN 46601-1070
(574) 289-0080
(574) 287-6320
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12008287
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100409820A
—
IN
Enumeration date
03/23/2006
Last updated
04/18/2012
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