Provider Demographics
NPI:1720413818
Name:CANALES ORTHODONTICS, LLC
Entity Type:Organization
Organization Name:CANALES ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANALES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:205-540-2889
Mailing Address - Street 1:909 MOUNT OLIVE RD
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-3638
Mailing Address - Country:US
Mailing Address - Phone:205-631-6033
Mailing Address - Fax:205-631-1033
Practice Address - Street 1:909 MOUNT OLIVE RD
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-3638
Practice Address - Country:US
Practice Address - Phone:205-631-6033
Practice Address - Fax:205-631-1033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-07
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL60061223X0400X
AL56351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty