Individual
DR. KATHERINE ANNE DECOLIBUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
10825 OLD HIGHWAY 64, BOLIVAR, TN 38008-3599
(731) 658-5291
(731) 658-6536
Mailing address
4132 POPLAR AVE, MEMPHIS, TN 38117-3618
(901) 680-0377
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7389
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16170
—
TN
Enumeration date
08/05/2006
Last updated
08/06/2009
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