NPIMap

Organization Active NPI

Robert F. Colwell Jr, DDS, PC

  • Dental Clinic/Center
  • Bellevue, NE
National Provider Identifier
1629354667
Registry record updated Jan 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
6236 Issued in NE
Legal business name
ROBERT F. COLWELL JR, DDS, PC
Practice address
712 Fort Crook Rd N
Bellevue, NE 68005-4558
Phone
(402) 733-6066
Fax
(402) 733-0899
NPI assigned
Oct 21, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert Frazier Colwell Jr., DDS
Title
President/Owner
Phone
(402) 733-6066

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 6236 NE Primary
Dental Clinic/Center 261QD0000X 8073 IA

Addresses

Primary practice location

712 Fort Crook Rd N
Bellevue, NE 68005-4558

Mailing address

712 Fort Crook Rd N
Bellevue, NE 68005-4558
Phone (402) 733-6066

Other identifiers 2

IdentifierTypeStateIssuer
10025204800MedicaidNE
15558428003MedicaidIA

Other names 1

  • Southroads Dental &/or Dream Dental Care Doing business as

National Provider Directory

National Provider Directory

Locations

712 Fort Crook Rd N
Bellevue, NE 68005
Phone (402) 733-6066

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1319155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327276800000",
    "number": "1629354667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 FORT CROOK RD N",
            "city": "BELLEVUE",
            "state": "NE",
            "postal_code": "680054558",
            "telephone_number": "402-733-6066",
            "fax_number": "402-733-0899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 FORT CROOK RD N",
            "city": "BELLEVUE",
            "state": "NE",
            "postal_code": "680054558",
            "telephone_number": "402-733-6066",
            "fax_number": "402-733-0899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT F. COLWELL JR, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-21",
        "last_updated": "2012-01-23",
        "status": "A",
        "authorized_official_last_name": "COLWELL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "FRAZIER",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "402-733-6066",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NE",
            "license": "6236",
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IA",
            "license": "8073",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025204800",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "15558428003",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southroads Dental &/or Dream Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bellevue, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.