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Edison Lakes Oral Surgery, P.c.
Oral and Maxillofacial Surgery Clinic/Center in South Bend, Indiana
NPI 1881887065

Edison Lakes Oral Surgery, P.c. is a Oral and Maxillofacial Surgery Clinic/Center based in South Bend, IN and is specialized in Oral and Maxillofacial Surgery. Edison Lakes Oral Surgery, P.c. practices in South Bend, IN. The NPI Number for Edison Lakes Oral Surgery, P.c. is 1881887065 and holds a License No. (Indiana).

The current practice location address for Edison Lakes Oral Surgery, P.c. is 3367 Douglas Rd, South Bend, IN and can be reached out via phone at 574-272-8823 and via fax at 574-277-1837.

Location: 3367 Douglas Rd, South Bend, IN, 46635-1779
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1881887065
Provider Name
Edison Lakes Oral Surgery, P.c.
Credential
Provider Entity Type
Organization
Address
3367 Douglas Rd, South Bend, IN, 46635-1779
Phone Number
574-272-8823
Fax Number
574-277-1837
Provider Enumeration Date
08/22/2007
Last Update Date
05/18/2024
institution
Provider Business Practice Location Address Details
Address
3367 Douglas Rd
City
South Bend
State
Indiana
Zip
46635-1779
Phone Number
574-272-8823
Fax Number
574-277-1837
person
Provider Business Mailing Address Details
Address
3367 Douglas Rd
City
South Bend
State
Indiana
Zip
46635-1779
Phone Number
574-272-8823
Fax Number
574-277-1837
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Oral and Maxillofacial Surgery
Taxonomy
1223S0112X
License No.
12010802A (Indiana)
Definition
The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
person
Provider's Taxonomy Details 2
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Oral and Maxillofacial Surgery
Taxonomy
261QS0112X
License No.
()
Definition
The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
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