Michiana Oral &Maxillofacial Surgery LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

12008287 Issued in IN

Legal business name

MICHIANA ORAL &MAXILLOFACIAL SURGERY LLC

Practice address

707 N Michigan St
Suite 300
South Bend, IN 46601-1070

Phone

(574) 289-0080

Fax

(574) 287-6320

NPI assigned

Mar 23, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bernard J Asdell, DDS

Title

Owner

Phone

(574) 289-0080

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334707200000",
    "number": "1093775272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 N MICHIGAN ST",
            "address_2": "SUITE 300",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011070",
            "telephone_number": "574-289-0080",
            "fax_number": "574-287-6320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 N MICHIGAN ST",
            "address_2": "SUITE 300",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011070",
            "telephone_number": "574-289-0080",
            "fax_number": "574-287-6320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIANA ORAL &MAXILLOFACIAL SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-23",
        "last_updated": "2012-04-18",
        "status": "A",
        "authorized_official_last_name": "ASDELL",
        "authorized_official_first_name": "BERNARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "574-289-0080",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IN",
            "license": "12008287",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100409820A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michiana Gastroenterology, Inc
• Michiana Hearing Care Center, P.C.
• Michiana Home Services, Inc. (Always Best Care Michiana - Home Health)
• Michiana Home Services, Inc. (Always Best Care-Michiana)
• Michiana Nutrition and Diabetes Education LLC
• Michiana Speech Lab LLC
• Anne Marie Micinski, ATC, LAT
• Joshua Mickels
• Rachel Mickelson
• Kahmiil Kohrie Middleton, LMSW

• Oral and Maxillofacial Surgery (Dentist) in South Bend, IN
• Providers in South Bend, IN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.