Provider Demographics
NPI:1861374969
Name:CANADA, CALEB (DDS)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:CANADA
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 1:8102 HAMILTON MILL DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2767
Mailing Address - Country:US
Mailing Address - Phone:423-902-6019
Mailing Address - Fax:
Practice Address - Street 1:651 E 4TH ST STE 301
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-1932
Practice Address - Country:US
Practice Address - Phone:423-756-0957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN129151223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice