Provider Demographics
NPI:1700489598
Name:CANESSA, ATILIO ANDRES (DDS)
Entity Type:Individual
Prefix:
First Name:ATILIO
Middle Name:ANDRES
Last Name:CANESSA
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 1:1076 N COAST HIGHWAY 101 APT 2
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1420
Mailing Address - Country:US
Mailing Address - Phone:310-948-7987
Mailing Address - Fax:
Practice Address - Street 1:191 N EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5362
Practice Address - Country:US
Practice Address - Phone:760-203-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1055691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice