Provider Demographics
NPI:1417443797
Name:DOUGLAS R. SEWELL DMD PLLC.
Entity Type:Organization
Organization Name:DOUGLAS R. SEWELL DMD PLLC.
Other - Org Name:CHERRY CREEK FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-722-3900
Mailing Address - Street 1:695 S COLORADO BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-8013
Mailing Address - Country:US
Mailing Address - Phone:303-722-3900
Mailing Address - Fax:
Practice Address - Street 1:695 S COLORADO BLVD STE 300
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-8013
Practice Address - Country:US
Practice Address - Phone:303-722-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00010670261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental