Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Edison Lakes Oral Surgery, PC

Organization Oral and Maxillofacial Surgery (Dentist) · NPI 1881887065

Edison Lakes Oral Surgery, PC is an Oral and Maxillofacial Surgery (Dentist) in South Bend, Indiana. Licensed in Indiana. Registered with an NPI since 2007.

Licensed in
IN
In the registry since
2007
Specialties on file
2
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3367 Douglas Rd
South Bend, IN 46635-1779
Phone: (574) 272-8823
Fax: (574) 277-1837
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Oral and Maxillofacial Surgery Clinic/Center (primary) Taxonomy 261QS0112X · Licence 12010802A (IN)
Oral and Maxillofacial Surgery (Dentist) Taxonomy 1223S0112X

Record details

NPI number1881887065
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Edward Collins — Owner · (574) 272-8823
Other names Oral Surgery Michiana
NPI enumeratedAugust 22, 2007
Last updated in NPPESMay 6, 2024
Certification dateMay 6, 2024
Mailing address3367 Douglas Rd, South Bend, IN 46635-1779

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