Provider Demographics
NPI:1851054894
Name:CORPUZ, PATRICK S (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:S
Last Name:CORPUZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6162 KINDLEWOOD COVE WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5326
Mailing Address - Country:US
Mailing Address - Phone:702-556-3378
Mailing Address - Fax:
Practice Address - Street 1:10870 W CHARLESTON BLVD STE 170
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-1170
Practice Address - Country:US
Practice Address - Phone:702-254-6412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7571122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist