Organization
ROBERT F. COLWELL JR, DDS, PC
Active
Other names
Southroads Dental &/or Dream Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT FRAZIER COLWELL JR. DDS (PRESIDENT/OWNER)
(402) 733-6066
Entity
Organization
Contact information
Practice address
712 FORT CROOK RD N, BELLEVUE, NE 68005-4558
(402) 733-6066
(402) 733-0899
Mailing address
712 FORT CROOK RD N, BELLEVUE, NE 68005-4558
(402) 733-6066
(402) 733-0899
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
6236
NE
261QD0000X
Dental Clinic/Center
8073
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025204800
—
NE
05
—
15558428003
—
IA
Enumeration date
10/21/2011
Last updated
01/23/2012
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