Provider Demographics
NPI:1235454950
Name:COLLINS, EDWARD CHARLES III (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:CHARLES
Last Name:COLLINS
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:270 E DAY RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3444
Mailing Address - Country:US
Mailing Address - Phone:574-272-8823
Mailing Address - Fax:574-277-1837
Practice Address - Street 1:3367 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1779
Practice Address - Country:US
Practice Address - Phone:574-272-8823
Practice Address - Fax:574-277-1837
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012076A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201225610Medicaid
IN201225610Medicaid