Provider Demographics
NPI:1881991446
Name:COOMBS, CALEB V (DMD)
Entity type:Individual
Prefix:DR
First Name:CALEB
Middle Name:V
Last Name:COOMBS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:CALEB
Other - Middle Name:V
Other - Last Name:COOMBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1010 NE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526
Mailing Address - Country:US
Mailing Address - Phone:541-476-7483
Mailing Address - Fax:
Practice Address - Street 1:1010 NE 7TH ST.
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526
Practice Address - Country:US
Practice Address - Phone:541-476-7483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9521122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist