Organization
EDISON LAKES ORAL SURGERY, P.C.
Active
Other names
Oral Surgery Michiana
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD CHARLES COLLINS III DDS, MS (OWNER)
(574) 272-8823
Entity
Organization
Contact information
Practice address
3367 DOUGLAS RD, SOUTH BEND, IN 46635-1779
(574) 272-8823
(574) 277-1837
Mailing address
3367 DOUGLAS RD, SOUTH BEND, IN 46635-1779
(574) 272-8823
(574) 277-1837
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
12010802A
IN
Other
Enumeration date
08/22/2007
Last updated
05/06/2024
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