Provider Demographics
NPI:1093271827
Name:CANALES, SUANE ANN (DMD)
Entity Type:Individual
Prefix:
First Name:SUANE
Middle Name:ANN
Last Name:CANALES
Suffix:
Gender:F
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:PLAZA DEL SOL MALL SUITE 40
Mailing Address - Street 2:SUITE 40 LOCAL 1100A
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-780-4300
Mailing Address - Fax:
Practice Address - Street 1:725 WEST MAIN PLAZA DEL SOL
Practice Address - Street 2:LOCAL 1100A
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-780-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR32991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3299OtherJDE