Provider Demographics
NPI:1629078167
Name:COLWELL, BRUCE F (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:F
Last Name:COLWELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3895 SW 185TH AVE
Mailing Address - Street 2:#170
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-1573
Mailing Address - Country:US
Mailing Address - Phone:503-649-6497
Mailing Address - Fax:503-649-2985
Practice Address - Street 1:3895 SW 185TH AVE
Practice Address - Street 2:#170
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97007-1573
Practice Address - Country:US
Practice Address - Phone:503-649-6497
Practice Address - Fax:503-649-2985
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR 6682122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR6682OtherOR LICENSE