Provider Demographics
NPI:1497105316
Name:CANAL, CHAD ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:ANDREW
Last Name:CANAL
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 1:1950 INDIANAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-3135
Mailing Address - Country:US
Mailing Address - Phone:765-364-1740
Mailing Address - Fax:765-364-0031
Practice Address - Street 1:1950 INDIANAPOLIS RD
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-3135
Practice Address - Country:US
Practice Address - Phone:765-364-1740
Practice Address - Fax:765-364-0031
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012477A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist