Provider Demographics
NPI:1710611025
Name:KOLIBABA, CAITLINN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAITLINN
Middle Name:
Last Name:KOLIBABA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 THOMAS AVE APT 537
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3982
Mailing Address - Country:US
Mailing Address - Phone:503-449-4838
Mailing Address - Fax:
Practice Address - Street 1:3121 N PRESIDENT GEORGE BUSH HWY STE 113
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-2753
Practice Address - Country:US
Practice Address - Phone:469-368-9889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX388451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program