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General NPI Number Information
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NPI Number | 1568625705
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Entity Type | Organization
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Legal Business Name | SUNSET DENTAL PA
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 401 HOOKS AVE STE E
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City | DONNA
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State | TX
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Zip | 78537-3036
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Country | US
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Telephone | 956-464-2223
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 HIGHLAND PARK AVE STE G
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City | MISSION
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State | TX
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Zip | 78572-4452
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Country | US
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Telephone | 956-585-1711
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Fax | 956-584-8529
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Authorized Official
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Title or Position | OWNER
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Name | DR. TOMAS ADOLFO CANALES
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Credential | DDS
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Telephone | 956-464-2223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14908
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License Number State | TX
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