Provider Demographics
NPI:1568625705
Name:SUNSET DENTAL PA
Entity Type:Organization
Organization Name:SUNSET DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMAS
Authorized Official - Middle Name:ADOLFO
Authorized Official - Last Name:CANALES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-464-2223
Mailing Address - Street 1:1001 HIGHLAND PARK AVE
Mailing Address - Street 2:STE G
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-4452
Mailing Address - Country:US
Mailing Address - Phone:956-585-1711
Mailing Address - Fax:956-584-8529
Practice Address - Street 1:401 HOOKS AVE
Practice Address - Street 2:STE E
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-3036
Practice Address - Country:US
Practice Address - Phone:956-464-2223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX149081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120948801Medicaid