Healthcare Provider Details

I. General information

NPI: 1568625705
Provider Name (Legal Business Name): SUNSET DENTAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HOOKS AVE STE E
DONNA TX
78537-3036
US

IV. Provider business mailing address

1001 HIGHLAND PARK AVE STE G
MISSION TX
78572-4452
US

V. Phone/Fax

Practice location:
  • Phone: 956-464-2223
  • Fax:
Mailing address:
  • Phone: 956-585-1711
  • Fax: 956-584-8529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14908
License Number StateTX

VIII. Authorized Official

Name: DR. TOMAS ADOLFO CANALES
Title or Position: OWNER
Credential: DDS
Phone: 956-464-2223