Provider Demographics
NPI:1770674848
Name:COLWELL, ROBERT FRAZIER JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FRAZIER
Last Name:COLWELL
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 FORT CROOK RD N
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-4558
Mailing Address - Country:US
Mailing Address - Phone:402-733-6066
Mailing Address - Fax:402-733-0899
Practice Address - Street 1:712 FORT CROOK RD N
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-4558
Practice Address - Country:US
Practice Address - Phone:402-733-6066
Practice Address - Fax:402-733-0899
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6236122300000X
IA8073122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025204800Medicaid
IA15558428003Medicaid