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General NPI Number Information
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NPI Number | 1710611025
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Entity Type | Individual
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Provider Name | CAITLINN KOLIBABA DDS
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Gender | Female
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Dates
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Enumeration Date | 07/12/2022
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Last Update Date | 08/16/2022
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Provider Practice Location Address
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Address Line | 3121 N PRESIDENT GEORGE BUSH HWY STE 113
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City | GARLAND
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State | TX
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Zip | 75040-2753
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Country | US
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Telephone | 469-368-9889
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Fax |
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Provider Business Mailing Address
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Address Line | 3110 THOMAS AVE APT 537
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City | DALLAS
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State | TX
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Zip | 75204-3982
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Country | US
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Telephone | 503-449-4838
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 38845
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License Number State | TX
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