Provider Demographics
NPI:1174638845
Name:MARIO J. CANAL DMD, PC
Entity Type:Organization
Organization Name:MARIO J. CANAL DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CANAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-439-1200
Mailing Address - Street 1:285 S CHURCH ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-2773
Mailing Address - Country:US
Mailing Address - Phone:856-439-1200
Mailing Address - Fax:856-439-1106
Practice Address - Street 1:285 S CHURCH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2773
Practice Address - Country:US
Practice Address - Phone:856-439-1200
Practice Address - Fax:856-439-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI016539001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty