NPIMap

Organization Active NPI

Edison Lakes Oral Surgery, P.C.

Doing business as Oral Surgery Michiana

  • Oral and Maxillofacial Surgery Clinic/Center
  • South Bend, IN
National Provider Identifier
1881887065
Registry record updated May 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X
License
12010802A Issued in IN
Legal business name
EDISON LAKES ORAL SURGERY, P.C.
Doing business as
Oral Surgery Michiana
Practice address
3367 Douglas Rd
South Bend, IN 46635-1779
Phone
(574) 272-8823
Fax
(574) 277-1837
NPI assigned
Aug 22, 2007
Last updated
May 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2024

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

Authorized official

Name
Dr. Edward Charles Collins III, DDS, MSNPI 1235454950
Title
Owner
Phone
(574) 272-8823

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery Clinic/Center 261QS0112X 12010802A IN Primary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X NU

Addresses

Primary practice location

3367 Douglas Rd
South Bend, IN 46635-1779

Mailing address

3367 Douglas Rd
South Bend, IN 46635-1779
Phone (574) 272-8823

Other names 1

  • Oral Surgery Michiana Doing business as

National Provider Directory

National Provider Directory

Locations

270 E Day Rd
Ste 260
Mishawaka, IN 46545
Phone (574) 272-8823

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1187740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714953600000",
    "number": "1881887065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3367 DOUGLAS RD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351779",
            "telephone_number": "574-272-8823",
            "fax_number": "574-277-1837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3367 DOUGLAS RD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351779",
            "telephone_number": "574-272-8823",
            "fax_number": "574-277-1837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDISON LAKES ORAL SURGERY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-22",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "574-272-8823",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "IN",
            "license": "12010802A",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oral Surgery Michiana",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Bend, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; 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.