MEDICARE: DR. EDWARD CHARLES COLLINS III DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	12012076A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235454950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD CHARLES COLLINS III DDS

Provider Business Mailing Address
First Line	:	270 E DAY RD
Second Line	:	SUITE 260
City	:	MISHAWAKA
State	:	IN
Zip	:	46545-3444
Country	:	US
Telephone Number	:	574-272-8823
Fax Number	:	574-277-1837

Provider Business Practice Location Address
First Line	:	3367 DOUGLAS RD
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46635-1779
Country	:	US
Telephone Number	:	574-272-8823
Fax Number	:	574-277-1837

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2010
Last Update Date	:	12/21/2021

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