Provider Demographics
NPI:1689782674
Name:CANAL, EMILIO JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:
Last Name:CANAL
Suffix:JR
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 1:11290 STONES THROW DR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-1045
Mailing Address - Country:US
Mailing Address - Phone:703-318-6578
Mailing Address - Fax:
Practice Address - Street 1:11465 SUNSET HILLS RD
Practice Address - Street 2:SUITE 600
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5235
Practice Address - Country:US
Practice Address - Phone:703-318-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010074861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice