Robert Patrick Sewell, DMD
Individual provider Active NPI General Practice Dentistry · Dulce, NM
NPI 1922178359 · NPPES record last updated May 27, 2008
Key facts
- NPI
- 1922178359
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 7937 (CO)
- Practice address
- 12000 Stone Lake Rd
Dulce, NM 87528 - Phone
- (505) 759-7211
- NPI assigned
- Nov 9, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7937 | CO | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jicarilla IHS Pharmacy | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 7937 | CO | Yes |
Addresses
Primary practice location
12000 Stone Lake Rd
Dulce, NM 87528
Mailing address
12000 Stone Lake Road
Dulce, NM 87528
Phone (505) 759-7211
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HSZ196 | Other | NM | MEDICARE PART B |
| 000K3526 | Medicaid | NM |
Other providers in Dulce, NM
- Kelly Rae Pettigrew
- Eric J Polczynski
- Theresa Ann Posey
- Gaylia Dianne Pride
- Marcia Ann Sahmaunt
- John E Shumack
- Melissa Marie Trujillo
- Marlene Joy Velarde
- Susan Ann Velarde
- Inna Voinich
All providers in Dulce, NM · General Practice Dentistry in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 27, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.