Provider Demographics
NPI:1639296148
Name:CANALES, TOMAS ADOLFO (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOMAS
Middle Name:ADOLFO
Last Name:CANALES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:956-585-4341
Mailing Address - Fax:956-584-8529
Practice Address - Street 1:1001 HIGHLAND PARK AVE
Practice Address - Street 2:STE G
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-4452
Practice Address - Country:US
Practice Address - Phone:956-585-4341
Practice Address - Fax:956-584-8529
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX149081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX051217OtherCHIPS