Provider Demographics
NPI:1942793989
Name:CARLOS, LYLE ARRIAN CORPUZ (DMD)
Entity Type:Individual
Prefix:DR
First Name:LYLE ARRIAN
Middle Name:CORPUZ
Last Name:CARLOS
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 1:2905 HARRIET AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1651
Mailing Address - Country:US
Mailing Address - Phone:808-597-4908
Mailing Address - Fax:
Practice Address - Street 1:12737 ELM CREEK BLVD N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7045
Practice Address - Country:US
Practice Address - Phone:763-218-7005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND140461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice