Provider Demographics
NPI:1902131121
Name:LYLES, ANN MICHELLE (DDS)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MICHELLE
Last Name:LYLES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:LYLES
Other - Last Name:MACPHAIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:975 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0117
Mailing Address - Country:US
Mailing Address - Phone:408-871-1964
Mailing Address - Fax:408-871-7161
Practice Address - Street 1:975 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0117
Practice Address - Country:US
Practice Address - Phone:408-871-1964
Practice Address - Fax:408-871-7161
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA454911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice